Monitoring the Progression of Aortic Stenosis
Aortic stenosis is a disease that progresses—it gets worse over time. To protect your health, you need to monitor your condition on a regular basis especially if you have severe aortic stenosis. As this disease progresses, you may need life-saving surgery—aortic valve replacement.
Of the 1.5 million people in the United States who have aortic stenosis, about 500,000 have severe stenosis. About 85,000 aortic valve replacement surgeries are performed every year, which means not everyone who has severe aortic stenosis has surgery. For some people, the operation may be too risky because of other health problems. Others might not be candidates for surgery because their symptoms aren’t severe enough.
Monitoring the progression of aortic stenosis is all about deciding when surgery may be necessary for you.
The Details of Monitoring
Doctors monitor aortic stenosis the same way they diagnose it. They ask about your symptoms and listen to your heart. You also will have an echocardiogram, which makes a moving picture of the inside of your heart. This lets the doctor see the size of the aortic valve. The test also measures the speed that blood flows through the valve and the pressure on either side of it.
The first time you have this test, it will show whether you have mild, moderate or severe stenosis. Follow-up tests show how the disease is progressing.
If your aortic stenosis is severe, but not severe enough for surgery right away, repeated testing with an echocardiogram will let your doctor monitor your condition. You may need an echocardiogram once every 3 to 5 years when you have mild aortic stenosis. If you have severe aortic stenosis, you may need one every year.
If your aortic stenosis is severe but you don't have symptoms, your doctor might also recommend an exercise test. This will show how your heart responds to activity. It also will show whether symptoms start under certain conditions.
It's important to stay in touch with your doctor between tests. Report any changes in symptoms and any new symptoms. The best type of doctor for monitoring aortic stenosis is a cardiologist, a heart specialist.
Signs You Might Need Surgery
Your doctor may suggest aortic valve replacement when:
You have severe aortic stenosis and symptoms. These may include chest pain, fainting, shortness of breath, and fatigue after activity.
You have severe aortic stenosis with some symptoms that get worse during an exercise test.
- You have severe aortic stenosis without symptoms, but the amount of blood flowing through your valve is less than half what it should be.
Keeping a Healthy Heart
While your doctor is monitoring your aortic stenosis, it's important that you do your best to promote heart health. High blood pressure, atrial fibrillation, and coronary artery disease are all common in people with aortic stenosis. Make sure you work with your doctor to treat these conditions if you have them.
You can take other heart-healthy steps on your own:
Take an aspirin every day if your doctor says it is okay.
- Avoid strenuous exercise with severe aortic stenosis. However, ask your doctor if there are moderate types of exercise that would be right for you.
An echocardiogram and your symptoms determine how severe your aortic stenosis is.
Your doctor will monitor severe aortic stenosis with repeat echocardiograms if you don’t need surgery yet.
Once symptoms start, aortic valve replacement is the only treatment for severe aortic stenosis.
While watching for signs that you need surgery, always tell your doctor about any symptoms; and work as a team to keep your heart as healthy as possible.
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- Clinical Update: Severe Stenosis Options, Circulation, 2011; 124: 355-3. http://circ.ahajournals.org/content/124/3/355.full
- Facts, University of Maryland Medical Center. http://umm.edu/programs/heart/services/programs/surgery/valve-surgery/facts
- Aortic Stenosis: Diagnosis and Treatment, American Family Physician. http://www.aafp.org/afp/2008/0915/p717.html
- Severe Aortic Stenosis and Aortic Valve Replacement, Penn Medicine. http://www.pennmedicine.org/heart/patient/resources/patient-information/TAVR-patient-FAQ.pdf