American Medical Association Family Medical Guide - American Medical Association [348]
Cardiac catheterization
Aortic stenosis can be confirmed with cardiac catheterization. In this procedure, a catheter (a thin, flexible tube) containing an electronic device that measures pressure is guided through an artery to the heart to measure the pressure in the left ventricle and in the aorta.
Surgery is the usual treatment for aortic stenosis that is causing symptoms. If the doctor thinks that surgery may be necessary to repair the stenosis, you will probably have a coronary angiogram (see page 561) to evaluate the severity of the aortic stenosis and determine if there are any blockages in the coronary arteries.
The type of surgery performed most often is heart valve replacement surgery (see page 590). Balloon valvuloplasty (see page 589), a procedure in which a catheter containing a balloon is passed through a blood vessel to the valve to enlarge the valve opening, may be performed on people who are not good candidates for heart valve replacement surgery.
Aortic Insufficiency
If the aortic valve (the valve between the aorta and the left ventricle) does not close properly, aortic insufficiency (also called aortic incompetence or aortic regurgitation) may develop. The left ventricle of the heart pumps blood through the aorta (the main artery in the body) to body tissues. If the aortic valve does not close properly, blood can leak back into the left ventricle, causing a sound called a heart murmur, which a doctor can hear through a stethoscope. A congenital (present at birth) abnormality of the valve is usually the cause of aortic insufficiency. Other possible causes include infective endocarditis (a potentially life-threatening infection of the inner lining of the heart muscle; see right), syphilis (see page 483), or stretching of the tissues that support the aortic valve.
In severe cases of aortic insufficiency, the left ventricle enlarges and its walls thicken as the heart responds to an increased workload. The large volume of blood pumped into the aorta may cause the arteries to pulsate abnormally, which is a sign of severe aortic insufficiency. In some cases, the aortic valve ruptures as a result of damage caused by infective endocarditis.
Symptoms
In most cases, symptoms do not occur until many years after the problem begins to develop. However, if the valve suddenly ruptures or if the heart muscle loses its effectiveness, a person can have shortness of breath, fatigue, or other symptoms of congestive heart failure (see page 570).
Diagnosis
To diagnose aortic insufficiency, a doctor performs a physical examination and will order diagnostic tests such as an echocardiogram (see page 561), an ultrasound examination of the heart, or an electrocardiogram (ECG; see page 559), a recording of the electrical activity of the heart. The doctor also may order blood tests to rule out rheumatoid arthritis (see page 918), ankylosing spondylitis (see page 1002), or syphilis.
Treatment
The treatment for aortic insufficiency is the same as the treatment for aortic stenosis (see page 591). Heart valve replacement surgery (see page 590) is usually required.
Infective Endocarditis
The endocardium is the inner lining of the heart muscle and covering of the heart valves. If the endocardium is damaged, such as from mitral regurgitation (see page 589), bacteria or other germs can infect the damaged area. As the microorganisms multiply, they cause more damage to the endocardium and may travel through the bloodstream to other parts of the body. The microorganisms can form infected blood clots that can lodge in small arteries and block blood flow. Gradually, the multiplying microorganisms cause severe damage to the