Recognising & Treating Aortic Stenosis In The Elderly

As people grow older, daily activities become more challenging. There will be times when even watering the plants or walking down a flight of stairs can be tiring. Elderly patients often ignore these signs and consider them as a part of the ageing process. However, if this tiredness persists even while performing the simplest tasks and is accompanied by dizziness or breathing difficulties, it may be a sign of something more serious. One such condition affecting the heart is aortic stenosis.

What is aortic stenosis?

The heart pumps blood throughout the body. Compare the four chambers of the heart to four runners in a relay race. The flow of blood from one chamber to another is similar to the passing of the baton. However, unlike a race, this blood flow from one chamber to another is controlled by gates or valves. The valve which allows the blood to flow from the heart to the rest of the body is called the aortic valve. It is made up of three flaps that open and close like a door with every heartbeat. Aortic stenosis is caused when this valve does not function properly. As a result, the heart has to work harder than usual to pump blood. Over time, this strain can weaken the heart. 

Aortic stenosis mostly affects the elderly (>65 years) and is mainly caused due to age-related wear and tear and calcium buildup on the valve. Some other risk factors include a persistent strep throat infection, chronic kidney disease, and radiation therapy on the chest. In rare cases, this disease can also be present from birth (congenital).

If left untreated, aortic stenosis can lead to several complications such as heart failure, irregular heartbeat, strokes, and blood clots. Some of the key symptoms of aortic stenosis include:

• Shortness of breath

• Feeling dizzy 

• Fainting after strenuous activity

• Palpitations 

• Chest pain. 

However, in some older patients, severe aortic stenosis may just present as tiredness, which may be easily ignored. 

Doctors normally detect aortic stenosis via a heart murmur or a whooshing sound in the heart. They may also conduct a test called transthoracic echocardiography to confirm the diagnosis. Some other tests that may be needed include an exercise test, a computed tomography (CT) scan, or a positron emission tomography (PET) scan to gauge the severity of the condition.

Advanced treatment options

Treatment of aortic stenosis depends on its severity and symptoms. In severe cases, replacing the valve is the only way to restore normal heart function. Traditionally, it is replaced through surgery by cutting open the patient’s chest. This process is known as surgical aortic valve replacement (SAVR). However, SAVR cannot be carried out in frail patients and in those who suffer from other comorbidities. 

Advancements in treatment have resulted in the development of minimally invasive options such as transcatheter aortic valve replacement (TAVR). In this procedure, the doctor inserts a thin tube called a catheter through the leg of the patient to reach the heart and replace the valve. TAVR is extremely beneficial for high-risk patients who cannot be offered SAVR. Moreover, the recovery time is shorter and patients can resume their daily routine quickly. With advances, TAVR has also shown promise in treating low-risk patients.

Aortic stenosis can be a life-threatening condition if not diagnosed and treated on time. It requires careful management and attention. With advancements in medical treatment and surgical techniques, many patients with aortic stenosis can return to their routine without compromising their quality of life. Alongside treatment, regular follow-ups with a cardiologist are essential to monitor the patient and adjust treatment plans when needed. By staying informed and proactive, patients can face the challenges of aortic stenosis bravely.

Dr. Praveen Chandra

Guest Author Cardiologist and Chairman of Interventional Cardiology at Medanta Medicity, Gurgaon, India.