How does aortic stenosis cause heart failure

Acquired aortic valve stenoses include those caused by inflammation (endocarditis) and the wear and tear with increasing age. The aortic valve stenosis caused by natural wear and tear and calcium deposits usually occurs in patients older than 60 years. Various factors favor this wear process, which manifests itself in the form of bone tissue remodeling and calcification of the heart valve. This process roughly corresponds to that of the calcification of the coronary and other vessels, known as arteriosclerosis. High blood pressure, diabetes, smoking, excessively high calcium concentrations in the blood, but also genetic factors are conducive to a faster progression of this process.

Symptoms

As a rule, the remaining opening area correlates with the severity of the symptoms, i.e. the smaller the opening area, the more pronounced the patient's complaints. It is not uncommon for patients with milder forms of aortic valve stenosis to have no symptoms. In the case of higher-grade constrictions, however, clear signs of disease appear in most cases. The shortness of breath is one of the first complaints that the patient experiences first with heavy and later also with light strain (e.g. when tying shoes). The general performance therefore decreases. The shortness of breath is often linked to a feeling of tightness or oppression in the chest, which can increase to the typical left-sided heartache. Dizziness and short-term loss of consciousness (the patient goes black and falls) can occur due to a short-term insufficient supply of the brain due to low blood pressure during exercise.
Furthermore, many patients in advanced stages suffer from swelling (edema) of the ankles and lower legs due to the general damage to the heart.

Diagnosis

If the patient comes to the diagnosis with the above-mentioned symptoms, echocardiography (ultrasound of the heart) is the fastest and most informative examination method to determine and classify a disease of the heart valves and any other changes in the heart caused by it. Further examinations to complete the cardiological diagnosis are the EKG (electrocardiography) and an X-ray of the chest. If a heart valve operation is necessary, a catheter examination is carried out to determine the degree of severity and possible damage to the heart even more precisely or to determine a possible parallel narrowing of the coronary vessels. A thin wire is inserted into the artery of the groin on the forearm and from there pushed through the aorta to the mouth of the coronary arteries or into the region of the heart valve. Contrast agent is injected into the interesting parts of the vessel and heart sections via the catheter and made visible under a mobile X-ray device.

therapy

A high-grade stenosis of the aortic valve is treated nowadays in the form of an operative replacement of the valve.
In principle, a distinction is made between two types of heart valve prostheses: artificial heart valves and biological heart valves.
Artificial (mechanical) heart valves have two metallic wings which, like a valve, ensure that the valve opens and closes. With this type of heart valve prosthesis, lifelong blood thinning through medication (Marcumar®, Falithrom®) is necessary. The almost unlimited shelf life is advantageous. The quality of the blood thinning is tested by taking regular blood samples, which you can do yourself if necessary.
Biological prostheses have roughly the same structure as the natural valve. They are made from tissue that comes from the pericardium of cattle or pigs. In the case of biological prostheses, lifelong blood thinning is not necessary, but the disadvantage is the durability of these valve types, which is around 10 to 15 years.
The selection of the respective valve type is determined in close coordination between the cardiac surgeon and the patient and depends on many factors, such as the age of the patient, the desire to have children, any concomitant diseases and the type of heart valve disease. So-called stentless valves are also rarely used; these are scaffold-free valves.