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Aortic valve stenosis can lead to other problems with the heart. And aortic valve stenosis can happen along with other heart valve problems.
Heart failure is the most common and potentially the most
life-threatening complication of
aortic valve stenosis.
Aortic valve stenosis causes a buildup of pressure inside the heart chamber that pumps blood to the body (the left ventricle). The ventricle compensates for the pressure by
thickening and pumping harder to force blood through the narrowed valve.
Your heart can work hard for a long time to compensate for the narrowed aortic valve. In fact, your heart compensates so well that you may
not feel any symptoms of stenosis for many years, even decades. But eventually
the valve becomes too narrow and your heart can no longer keep up. The effort
of pumping so hard under pressure year after year will wear out your heart
When the heart wears out, a person starts to have symptoms like shortness of breath. Symptoms happen because the left ventricle can no
longer compensate and the pressure begins to stretch (dilate) the heart muscle.
Eventually the heart loses its ability to pump enough blood to meet the body's
As your heart
loses its ability to pump blood to your body, your heart also cannot supply enough oxygen-rich blood to its own muscle. Your heart muscle starts to suffer from lack of oxygen, and heart failure continues to progress.
If you have heart failure, you might also get atrial fibrillation, a type of irregular heartbeat. Because heart failure causes the heart to stretch out of shape, it changes the electrical system of the heart. And this change can lead to atrial fibrillation.
Endocarditis is an infection of the heart's valves or its inner lining (endocardium). It is most common in people who have a damaged, diseased, or artificial heart valve.
If you have a problem with your heart that affects normal blood flow through the heart, it is more likely that bacteria or fungi will attach to heart tissue. This puts you at a higher risk for endocarditis.
If you have certain heart conditions, getting endocarditis is even more dangerous for you. These heart conditions include having an artificial heart valve, having a congenital heart defect, having had endocarditis in the past, and having a heart valve problem after a heart transplant.
The aortic and mitral valves are very close together in the heart. Problems can happen in both valves at the same time. When this happens, the heart cannot pump blood as well as it can when there are no problems in the valves.
When aortic and mitral valve problems happen together, it might be hard for your doctor to know that both valves are affected. One valve problem can "mask" another. When blood arrives from your
lungs, it enters your left atrium, passes through the mitral valve into your
left ventricle, and then gets pumped out through your aortic valve. Because the
blood passes through the mitral valve first, the problem with your mitral valve
will typically be more prominent than aortic stenosis, essentially because it
is "upstream." In fact, the problem with your mitral valve may actually "mask"
your aortic stenosis.
Mitral valve regurgitation and aortic stenosis together form a
potentially dangerous combination, although it is relatively rare for the two
conditions to occur at the same time.
Mitral regurgitation refers to the leaking of blood from the left
ventricle back through the mitral valve because of improper or incomplete
closure of the valve. If the mitral valve is leaking, when the left ventricle
contracts it will force blood backward into the left atrium, making it even
harder for the ventricle to pump enough blood forward through the narrowed
Having both valve problems can cause problems like heart failure to happen sooner.
Severe aortic stenosis can cause mitral regurgitation or make it
worse. As the left ventricle begins to tire from the effort of pumping blood
through the narrowed aortic valve, eventually the pressure overload in the
ventricle begins to stretch out the heart muscle. This stretches the base of
the mitral valve, preventing the valve from closing properly and causing
Mitral valve stenosis is a
narrowing of the mitral valve, which restricts the flow of blood from your left
atrium into your left ventricle. If you have mitral stenosis along with aortic
stenosis, your heart cannot pump blood normally.
Mitral stenosis restricts the flow of blood into
your left ventricle and your aortic stenosis restricts the flow of blood out of
your ventricle, causing the ventricle itself to become small and stiff, with
thickened walls. Because the mitral valve is narrow, the left
atrium cannot pump a normal amount of blood into the left ventricle,
making it even harder for the left ventricle to pump enough blood through the
narrowed aortic valve.
Aortic regurgitation occurs when the aortic valve does not close
properly and blood leaks back into the left ventricle. When aortic stenosis and
regurgitation occur together, the effect of one of the two problems is usually
more pronounced. If aortic stenosis is the dominant problem, it is similar to
having aortic stenosis alone. If aortic regurgitation is the dominant problem,
then it is like having aortic regurgitation alone.
The one exception is that if both problems are severe enough to
affect the left ventricle, the effect may be big enough to require
valve replacement, even though neither problem alone would have required
surgery. Multiple valve problems are most serious
when both valve problems are moderate to severe. But aortic stenosis can
actually make other valve problems worse over time.
Sudden cardiac death occurs when the heart abruptly ceases to
function from one or more existing problems. Aortic valve replacement surgery lowers the risk of sudden death from aortic stenosis. Sudden death almost never occurs in people who do not yet have symptoms of
aortic valve stenosis.
In general, sudden death in people who have aortic valve
stenosis is closely associated with heart failure. Also, sudden death
can occur when severe stenosis and advancing heart failure cause an irregular
heartbeat or blocked vessels.
Other Works Consulted
Bonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
November 11, 2013
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & David C. Stuesse, MD - Cardiac and Thoracic Surgery
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