Valvular Disease Stenosis

Valvular stenosis occurs when a heart valve narrows, obstructing the flow of blood through the valve. Aortic stenosis (stenosis of the aortic valve) is the most common type of valvular stenosis, but any of the four heart valves may be affected.

The heart must pump harder to compensate for valvular stenosis. Left untreated, valvular stenosis can lead to heart failure and other complications.

Rheumatic Fever and Valvular Stenosis

Rheumatic fever is the most common cause of valvular stenosis. Rheumatic fever is an inflammatory disorder that is a complication of strep throat. Inflammation damages the heart valves, resulting in scar tissue that prevents the valves from closing properly.

Scar tissue resulting from rheumatic fever also provides an anchoring point for calcium deposits, further obstructing blood flow and exacerbating symptoms of valvular stenosis. Rheumatic fever may damage more than one heart valve.

Rheumatic Fever Worldwide

Rheumatic fever is no longer common in developed countries. Less developed countries, however, still have high rates of rheumatic fever, and as a result, high rates of valvular stenosis.

Rheumatic fever continues to influence valvular stenosis rates in developed countries, as older individuals who contracted rheumatic fever as children are now coping with valvular stenosis.

Causes: Aortic Stenosis and Valvular Stenosis

Rheumatic fever is the most common cause of three of the four types of valvular stenosis: pulmonary stenosis, tricuspid stenosis and mitral stenosis. The fourth type, aortic stenosis, is, in the absence of evidence of another cause, assumed to be congenital.

Less common causes of aortic stenosis and other valvular stenosis include heart valve calcification, especially aortic valve calcification, and coronary artery disease. A history of familial or individual heart valve disease also increases the risk of valvular stenosis.

Incidence Rates of Valvular Stenosis

Incidence rates for valvular stenosis vary. Aortic stenosis, the most common type of valvular stenosis, affects approximately five out of every 10,000 Americans and is more common in men than women. At the lower end of the scale is tricuspid stenosis, which affects less than one percent of the US population.

Valvular Stenosis Symptoms

Aortic stenosis and other forms of valvular stenosis are often asymptomatic—lacking symptoms—until the condition is quite advanced. As a result, while valvular stenosis may develop at any age, most symptoms appear in middle age. The most common symptoms are those associated with aortic stenosis, which include:

  • chest pain
  • dizziness
  • fainting
  • heart palpitations
  • shortness of breath when active
  • weakness.

In addition to these symptoms, valvular stenosis, particularly mitral valve stenosis, may also cause lung-related symptoms: coughing, blood traces in sputum and a high rate of respiratory infections.

Complications of Valvular Stenosis

Left untreated, aortic stenosis can cause permanent damage to the heart. The left ventricle chamber may enlarge to compensate for restricted blood flow, eventually causing heart failure.

Arrhythmias can also result from aortic stenosis. A heightened risk of endocarditis, most commonly caused by an infection of the heart lining and heart valves, is common to all forms of valvular stenosis.

Pulmonary hypertension, lung congestion and blood clots are other possible complications of valvular stenosis.

Diagnosing Valvular Stenosis

Valvular stenosis produces a distinct heart murmur and clicking noise when heard through a stethoscope. The overworked heart may also produce a noticeable chest heave and blood pressure readings may be unusually low.

Findings suggestive of valvular stenosis are confirmed with a number of diagnostic tests. Echocardiograms are most often used, but valvular stenosis may also be detected by cardiac catheterization, an electrocardiogram, Doppler ultrasonography or transesophageal echocardiogram.

Valvular Stenosis Treatment Options

When valvular stenosis is asymptomatic, or if symptoms are mild, the condition is monitored rather than treated. Should symptoms increase in severity, surgical repair or replacement of the affected heart valve is required. Monitoring must be vigilant, as valvular stenosis symptoms can appear suddenly, especially in cases of mitral valve stenosis.

Few other treatments for valvular stenosis exist. In some cases, aortic stenosis symptoms may be slowed with cholesterol-lowering medication. Prophylactic antibiotics prior to dental or medical surgery help reduce the risk of post-surgical endocarditis.

A heart-healthy diet and lifestyle is recommended for valvular stenosis patients. Individuals with aortic stenosis or other symptomatic valvular stenosis should avoid strenuous activity. Medical advice should be sought before starting any new exercise program.