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Aortic valve stenosis occurs when the aortic valve of the heart fails to open completely, preventing the normal flow of blood out of the left lower chamber of the heart (ventricle) and impeding the flow of oxygenated blood to the body. The aortic valve is the door-like structure between the main pumping chamber of the heart (left ventricle) and the major artery carrying blood to the body (aorta). The increased workload imposed on the left ventricle by the stenotic valve causes the ventricle to enlarge (hypertrophy). Over time, it may fail and lead to congestive heart failure.
Aortic stenosis is a congenital (50%) or acquired (50%) disorder of the aortic valve. Acquired narrowing (stenosis) of the valve may be caused by rheumatic fever or degenerative "wear and tear" related to high blood pressure, high blood cholesterol (hypercholesterolemia), or diabetes mellitus.
Risk: Men are affected more often than women. Incidence and Prevalence: Aortic stenosis is the most common reason for valve replacement in individuals over age 50. |
Source: Medical Disability Advisor
| History: The three principal symptoms of aortic stenosis are chest pain with exertion (angina pectoris), shortness of breath with exertion due to failure of the left ventricle (congestive heart failure), and sudden loss of consciousness (syncope). Symptoms usually do not develop until after age 50, but individuals may have had a heart murmur at an earlier age. Sometimes dizzy spells precede syncope. Similarly, mild shortness of breath with exertion often precedes congestive heart failure. Physical exam: The blood pressure is usually normal and the heart rhythm regular. In advanced cases there may be an abnormally low systolic as compared to the diastolic pressure (low pulse pressure). A heart murmur is audible with a stethoscope. A murmur due to associated leakage of the aortic valve (aortic insufficiency) and/or mitral valve disease may also be present. Tests: An electrocardiogram (ECG) often shows enlargement of the left ventricle. A chest x-ray may show evidence of congestive heart failure. An ultrasound of the heart (echocardiogram) and Doppler flow study allow precise evaluation of the severity of the stenosis. The ECG, chest x-ray, and echocardiogram are repeated at varying intervals to monitor the progression of the stenosis. A heart catheterization is done before valve surgery. |
Source: Medical Disability Advisor
| In the absence of symptoms, no treatment is necessary for aortic stenosis, except prophylactic treatment to prevent bacterial endocarditis.
Treatment is initiated if and when symptoms such as angina pectoris, congestive heart failure, or syncope develop. In most instances, valve replacement is performed at that time. |
Source: Medical Disability Advisor
| Individuals with mild aortic stenosis may have a normal life expectancy. However, symptoms often develop with moderate or severe aortic stenosis after age 50. After symptom onset, individuals with heart failure survive an average of 2 years; those with syncope, 3 years; and those with angina pectoris, 5 years. |
Source: Medical Disability Advisor
| Angina, congestive heart failure, and syncope may complicate aortic stenosis and necessitate surgery.
Individuals with aortic stenosis are at increased risk of acquiring a bacterial infection called acute or subacute bacterial endocarditis on the valve. This potentially devastating complication is due to bacteria in the mouth or gastrointestinal (GI) tract entering the bloodstream during dental work or an endoscopic procedure. It is easily preventable by taking appropriate antibiotics before the procedure. |
Source: Medical Disability Advisor
| In the absence of symptoms, no work restrictions or accommodations are necessary. Individuals who exhibit symptoms of aortic stenosis often need to limit their activity; a transfer to modified duties may be necessary. As symptoms arise, valve replacement is often considered. After successful valve replacement, activity is usually liberalized. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual exhibit early symptoms, such as dizziness and mild shortness of breath?
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Were symptoms of a developing stenosis evident, such as angina pectoris or syncope?
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Was echocardiogram performed? Was diagnosis confirmed?
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Is the aortic stenosis a congenital or acquired disorder?
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Has individual had rheumatic fever?
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Would individual benefit from consultation with a specialist (e.g., cardiologist, cardiac surgeon)?
Regarding treatment:
- Were prophylactic antibiotics given prior to dental work or endoscopic procedures to prevent a bacterial infection?
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Was surgical valve replacement indicated? If so, were appropriate medical interventions done to stabilize clinical symptoms prior to surgery?
Regarding prognosis:
- Were there any complications or comorbid conditions such as obesity, pulmonary disease, or diabetes mellitus?
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How severe was the stenosis?
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Did individual take antibiotic prophylaxis as recommended? Did bacterial endocarditis develop?
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Was surgical valve replacement done? Did individual experience any complications associated with the surgery, such as bleeding, rhythm disturbances or heart failure?
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What was the expected outcome?
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Source: Medical Disability Advisor
| "Aortic Valve Stenosis." MedicineNet.com. 16 Apr. 2002. MedicineNet, Inc. 19 May 2005 <http://www.medicinenet.com/aortic_stenosis/article.htm>. |
Source: Medical Disability Advisor