Ticking time bomb: Undiagnosed Aortic Valve Stenosis could have deadly consequences

By Kristy Bleizeffer Dec 10, 2018

Without knowing it, hundreds of Wyoming adults may be carrying ticking time bombs in their chests.

Aortic Valve Stenosis (AS) – a treatable but often undiagnosed heart condition – kills about 50 percent of adults within two years of the onset of symptoms. About half a million people in the United States are believed to have undetected AS.

The good news is that AS is treatable, and it can be detected through an echocardiogram. In this article, cardiologist Adrian Fluture, MD, FACC, FSCAI, explains the basics of AS and when you should talk to your doctor.

1.      What is Aortic Valve Stenosis (AS)?

AS is the narrowing of the valve to the heart’s largest blood vessel – the aorta. When the heart’s main pumping chamber contracts, the aortic valve opens and blood flows out to the rest of the body. Then, the main pumping chamber relaxes, the valve closes to prevent blood from leaking back into the heart, and a new heart cycle begins.

That valve is comprised of three leaflets which thicken as we age. In some people, this may gradually narrow the valve opening and lead to AS symptoms, typically first appearing in the patient’s 70s.

Some people, however, are born with aortic valves that have only two leaflets. This speeds up the narrowing process and the disease may manifest at a younger age.

2. What are the symptoms of AS?

When the valve opening becomes really narrow, it prevents blood from getting out of the heart to the rest of the body as it should. This forces the heart to work harder and leads to trouble over time.

Symptoms may include:

  • Feeling winded or light headed with physical activity. (For some people, this may mean walking to the mailbox or climbing a flight of stairs. Some people may notice becoming tired faster than they did a few months or one year ago and think that they are just becoming older. )
  • Chest pain or tightness with physical activity.
  • Fainting or almost fainting.

3. Is AS serious?

Left untreated, severe AS can lead to serious heart problems, heart failure and/or death. Once the patient starts feeling sick, the clock is ticking. Only about 50 percent of people with untreated AS are alive after two years.

4. How is AS treated?

AS is treated through surgery in most patients, and the negative effects of this disease can be almost completely reversed.  The most important factor in surviving AS is detecting the condition so it can be treated.

5. How is AS diagnosed?

When listening carefully to the patient’s heart, the doctor will hear an abnormal noise (heart murmur). He will then order a heart ultrasound, also known as echocardiogram. An echocardiogram can show detailed images of your heart in motion and detect abnormalities in blood flow and valve mechanics. It tells doctors if one has this disease and how serious it is.

Adults who have previously had heart murmurs, who may be at risk for AS or who are experiencing any of its symptoms, should talk to their doctors about whether an echocardiogram is warranted.

Aortic regurgitation (AR) is another condition in which the same valve does not close well and blood leaks back into the left lower pumping chamber. When serious, this also leads to heart failure and/or death. It can be detected and treated in similar ways with AS.

6. How common is AS?

Aortic stenosis is a common disease that affects about 1 in 8 people over the age of 75. Unfortunately, AS often goes undetected until it is too late. Nationally, studies suggest that nearly 500,000 U.S. citizens may have AS but do not know it.

Extrapolating from national statistics and considering our own demographics, it is estimated that there are hundreds of people in Wyoming who could have undiagnosed AS. That includes about 150 people in Natrona County.

7. What should people do if they believe they are at risk for AS?

Talk to your doctor if you have a heart murmur, a known heart defect from birth or if you have symptoms of AS as mentioned above.  Your doctor may order additional tests or refer you to a heart specialist.

Adrian Fluture, M.D.

Adrian Fluture M.D., F.A.C.C., F.S.C.A.I.

Adrian Fluture,  MD, FACC, FSCAI, specializes in cardiology, interventional cardiology, and vascular/endovascular medicine at Wyoming Cardiopulmonary Services in Casper. He is Director of Regional Myocardial Infarction at Wyoming Medical Center. He is board certified in cardiovascular disease, interventional cardiology, nuclear cardiology, echocardiography, vascular medicine, and resistant hypertension treatment.