Aortic valve disease warning: Watch for breathlessness and fainting

By Ahmet Taş | Wise News Press

ANKARA, TÜRKİYE — Aortic valve narrowing or leakage can progress without obvious symptoms, while breathlessness, chest pain, fainting and declining physical capacity may indicate that the heart is under increasing strain.

Located between the heart’s left ventricle and the aorta, which carries oxygen-rich blood to the body, the aortic valve keeps blood moving in the correct direction and prevents it from flowing back into the heart. When the valve cannot open sufficiently or close completely, blood circulation may be disrupted and heart function can gradually deteriorate.

Cardiovascular Surgery Specialist Prof. Dr. Yavuz Beşoğul said aortic valve diseases are more common among older adults but can also affect younger people because of congenital valve abnormalities, infections and certain connective tissue disorders. He emphasized that early diagnosis and appropriate treatment timing are important because the disease may progress for an extended period without causing noticeable symptoms.

Aortic stenosis increases the heart’s workload

Aortic stenosis occurs when blood leaving the heart has difficulty passing through the narrowed aortic valve. A healthy valve opens sufficiently when the heart contracts, allowing blood to flow freely from the left ventricle into the aorta.

The valve opening can become narrower when its leaflets thicken, develop calcium deposits or adhere to one another. The left ventricle must then generate greater pressure to pump blood through the restricted opening and into the body.

When this pressure burden continues for a long time, the heart muscle may become thicker. Although this response can initially help the heart manage the increased workload, the muscle may gradually lose its flexibility and its pumping function can deteriorate.

One of the main causes of aortic stenosis is age-related degenerative calcification. Structural changes that develop in the valve tissue over time can make the leaflets stiff and limit their movement, particularly among older adults.

Aortic stenosis or regurgitation can also develop at an earlier age in people born with a bicuspid aortic valve. In this condition, the valve has two leaflets rather than the usual three. A previous episode of rheumatic fever may also affect the valve, causing its leaflets to thicken and lose mobility.

Aortic regurgitation can enlarge the left ventricle

Aortic regurgitation develops when the valve does not close completely and some of the blood pumped into the aorta flows back into the left ventricle.

As a result, the heart has to handle a larger volume of blood than usual. The left ventricle must pump both the blood arriving from the lungs and the blood leaking back from the aorta into circulation.

A prolonged volume burden can cause the left ventricle to enlarge. The heart may initially adapt to this change, but its ability to contract effectively can decline as the condition progresses.

Aortic regurgitation may be associated with congenital valve abnormalities, infective endocarditis, enlargement of the aortic root and certain connective tissue disorders. Uncontrolled high blood pressure can also contribute to structural changes in the aorta and adversely affect valve function.

The condition can develop in either a chronic or acute form. Chronic aortic regurgitation may progress over several years. Acute and severe regurgitation caused by an infection or aortic dissection, however, can rapidly lead to heart failure and requires urgent medical assessment.

Breathlessness, chest pain and fainting require attention

The symptoms of aortic valve disease vary according to the type of valve disorder and how far it has progressed. Some patients may have no obvious complaints for a long time, while others can develop symptoms that significantly affect their daily lives.

Breathlessness is one of the most common symptoms. It may initially occur while climbing stairs, walking quickly or exercising. As the condition advances, breathing difficulties can begin during less demanding activities or even while resting.

Chest pain or a feeling of pressure in the chest can be an important warning sign, particularly in advanced aortic stenosis. An imbalance between the heart muscle’s rising oxygen requirements and its blood supply may contribute to this symptom.

Fainting or feeling close to fainting is another sign that needs careful evaluation. Fainting during physical exertion may be associated with advanced narrowing of the aortic valve.

Unusual tiredness and a decline in exercise capacity may indicate that the heart is having difficulty pumping enough blood around the body. Patients may also experience palpitations because of changes in their heart rhythm, although palpitations alone are not specific to aortic valve disease.

In more advanced cases, signs of heart failure may develop. These can include swelling around the ankles, breathlessness at night and difficulty breathing while lying down.

Echocardiography plays a central role in diagnosis

Listening to the patient’s symptoms and performing a physical examination are the first steps in diagnosing aortic valve disease. A heart murmur detected during examination may raise suspicion of a valve disorder.

However, not every murmur indicates serious valve disease. Similarly, the absence of a clearly detectable murmur does not completely rule out a problem affecting the aortic valve.

Echocardiography is the primary imaging method used to evaluate aortic valve disease. The examination allows physicians to assess valve movement, the direction of blood flow, the structure of the heart’s chambers and the heart’s pumping function.

In patients with aortic stenosis, physicians examine the speed of blood passing through the valve, the pressure differences created by the narrowing and the size of the valve opening. In aortic regurgitation assessment, the amount of blood flowing backward and its effects on the left ventricle are investigated.

Cardiac computed tomography, cardiovascular magnetic resonance imaging or coronary angiography may also be used when necessary. Computed tomography can be particularly useful in evaluating calcium deposits on the aortic valve and planning certain interventional procedures.

Echocardiography findings should be considered together with the patient’s symptoms, physical examination and general clinical condition. Treatment decisions may not always be adequately supported by a single measurement.

Treatment depends on severity and heart function

Treatment is planned according to the severity of the aortic valve disorder, the symptoms it causes and its effects on heart function.

Regular monitoring may be sufficient for mild or moderate valve disease. During follow-up, echocardiography can be performed at specific intervals to determine whether the condition is progressing.

Medication can help control accompanying problems such as high blood pressure, heart failure or heart rhythm disorders. However, medication cannot eliminate advanced structural narrowing of the aortic valve.

Valve replacement may be considered when aortic stenosis becomes severe and causes symptoms. Surgical aortic valve replacement is an effective treatment option for suitable patients.

In selected patients, aortic valve repair or replacement can be performed through an incision of approximately 4–5 cm in the underarm area. For older patients, particularly those aged 75 and above, transcatheter aortic valve implantation or replacement, known as TAVI or TAVR, may be evaluated.

The choice of treatment method is based on factors including the patient’s age, expected life span, surgical risk, valve anatomy and other clinical characteristics.

In aortic regurgitation, the presence of severe leakage, the development of symptoms, enlargement of the left ventricle or deterioration in heart function can influence the decision to operate. Valve repair may be possible in appropriate patients, while valve replacement may be required in other cases.

Early diagnosis may help protect the heart muscle

One of the main concerns in aortic valve disease is that the heart may continue working under increased pressure or volume for a long period.

The heart can initially compensate for this additional burden. As the disease progresses, however, thickening or enlargement of the heart muscle and a loss of function may develop.

Regular follow-up is therefore important even for patients with no obvious symptoms if advanced valve disease has been detected.

People experiencing breathlessness, chest pain during exertion, fainting or a marked reduction in physical capacity should not delay a cardiac assessment. Sudden severe chest pain, serious breathing difficulty or loss of consciousness may require emergency medical evaluation.

Treatment timing is an important part of managing aortic valve disease. Unnecessary early intervention should be avoided, but treatment should also not be delayed until changes that are difficult to reverse have developed in the heart muscle.

Regular medical examinations, appropriate imaging and an individualized treatment plan can help reduce the risk of serious complications associated with aortic valve disease.

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