Chest Pain Could Mean Aortic Valve Disease

By

Marijke Vroomen Durning, RN

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Chest pain can mean a lot of things. You might feel a throbbing tightness after running outside in cold weather, or a deep stinging after eating too much fried food. But chest pain isn’t always related to the weather or heartburn—in some cases, it can be a sign of something more serious, like aortic valve disease.


Your heart works hard every minute of the day, pumping your blood at just the right rate to help you function properly, whether you’re watching television or running a marathon. But just as the various parts of a mechanical pump can break down or get clogged up, so can parts of your heart, including the valves that control how your blood flows through your heart’s chambers.

The human heart has four chambers. Each chamber has a valve to control how much blood goes from one to the next and to prevent blood from flowing back into the previous chamber. The aortic valve controls your blood flow as it moves from the fourth chamber—the left ventricle, into the aorta—your body’s main artery. That valve can develop two problems: aortic valve stenosis and aortic valve regurgitation.

Aortic Valve Stenosis

In medical terms, when there is stenosis, there is narrowing. So aortic valve stenosis means the blood pathway through the aortic valve has narrowed, causing an obstruction. It is the most common heart valve problem in North America.

When the valve is blocked, it can cause a cascade of problems. The left ventricle must work harder to push the blood out through the aortic valve. Over time, the muscles may become thicker and less effective. If the heart can’t work hard enough to get the blood through the valve, the blood can begin to back up and accumulate in the chamber. This can cause your blood pressure to rise. And, if not enough blood is getting through to the aorta, the tissues in your body won’t be able to get the oxygen and nutrients they need to function properly.

Aortic Valve Regurgitation

With aortic valve regurgitation, your aortic valve doesn’t close properly after the heart has pumped blood from the chamber to the aorta. This allows some blood to flow backward, in the wrong direction. In other words, it’s a leaky valve. If you have regurgitation, your heart has to pump harder to get the blood out where it is supposed to be. It can come on gradually over a long period, or it can start suddenly, depending on the cause.

Causes of Aortic Valve Disease

You can be born with aortic valve disease or regurgitation, or it can develop over time. If you are born with aortic valve disease, it’s called a congenital heart defect. But most people develop aortic valve disease later in life. Although aortic stenosis can affect anyone at any age, age-related aortic valve stenosis often affects people 60 years of age or older. Symptoms may not begin to show for another 10 to 20 years, though. It’s most often caused by:

  • A buildup of calcium in the valve

  • Scarring in the valve

  • Rheumatic fever

Valve disease can also be caused by radiation to the chest, like radiation prescribed to treat cancer, as well as by autoimmune diseases, diet medicines (fenfluramine and phentermine), and other infections.

Symptoms of Aortic Valve Disease

Many people who have aortic valve stenosis or regurgitation don’t know it because they don’t have symptoms or the symptoms are very subtle. It is only when your heart starts to have trouble keeping up with the demand that symptoms become more noticeable.

The symptoms for aortic valve stenosis include:

  • Chest pain

  • Breathlessness or shortness of breath

  • Pressure or tightness in the chest

  • Fainting

  • Palpitations or a feeling of heavy, pounding or noticeable heartbeats

  • Inability to be as active as before

The symptoms for aortic valve regurgitation include:

  • Chest pain

  • Discomfort or tightness in your chest, often increasing during exercise

  • Fatigue and weakness, increasing with activity level

  • Shortness of breath when active or when you lie down

  • Swollen ankles and feet

  • Lightheadedness or fainting

  • Irregular pulse

  • Heart murmur

  • Sensations of a rapid, fluttering heartbeat

Diagnosing Aortic Valve Disease

There are several tests your doctor can use to determine if you have aortic valve disease. First, your doctor will need to take a full medical history and perform a physical examination to determine what could be causing the problem. After that, you may be sent for some of the following tests:

  • Chest X-ray

  • Blood tests

  • Electrocardiogram (ECG)

  • Echocardiogram

  • Exercise/stress tests

  • Cardiac magnetic resonance imaging (MRI)

  • Cardiac catheterization

Treatment

Once your doctor has determined you do have aortic valve disease, a treatment plan will be made. If your symptoms are mild to moderate, your doctor will likely keep you under observation. If your doctor takes this approach, you will need to undergo regular exams and tests to ensure that, if your valve disease does get worse, it will be caught as early as possible. And if the problem doesn’t worsen, you may never need any further treatment. If you have aortic valve regurgitation, your doctor may prescribe medicines to help regulate your heart rhythm.

The other option for treatment is surgery to repair or replace the blocked or faulty valve. This may be performed as open heart surgery or with minimally invasive surgery. With open heart surgery, the surgeon opens your chest to access the heart. With minimally invasive surgery, the surgeon makes a few tiny incisions and uses special instruments and a camera (to visualize the heart) to perform the surgery. The type of surgery your doctor chooses will depend on the facility, his or her experience with the procedure, the type of repairs needed, and your overall health, among other things.

Whether you need surgery or you are being observed, there are actions you can take to help your heart stay as healthy as possible. They include:

  • Eating a heart healthy diet

  • Exercising regularly (following your doctor’s guidance)

  • Maintaining a healthy body weight

  • If you have high blood pressure, following a prescribed treatment plan

  • Seeing your doctor regularly

Prognosis

Aortic valve disease has a good prognosis, or outcome. Of the sudden heart deaths that occur every year, fewer than 4% of them are caused by aortic valve stenosis. Close monitoring by you and your doctor will help identify if your symptoms become more frequent or worse, and this may change your treatment plan.

Living with aortic heart disease may seem frightening, but speak with your doctor to see what treatments and approaches are best for you. Taking care of your heart is the best thing you can do for yourself.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 7, 2017

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Medical References

  1. Aortic Valve Disease. Cleveland Clinic. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/aortic-valve-disease/
  2. Problem: Aortic Valve Stenosis. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Problem-Aortic-Valve-Stenosis_UCM_450437_Article.jsp#.VuqrFbSqyQI
  3. What Causes Heart Valve Disease? National Heart, Lung and Blood Institute. Part of the National Institutes of Health.