Aortic Stenosis - Cause

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What causes aortic stenosis?

In adults, three conditions are known to cause aortic stenosis.

  1. Progressive wear and tear of a bicuspid valve present since birth (congenital).
  2. Wear and tear of the aortic valve in the elderly.
  3. Scarring of the aortic valve due to rheumatic fever as a child or young adult.

Bicuspid aortic valve is the most common cause of aortic stenosis in patients under age 65. Normal aortic valves have three thin leaflets called cusps. About 2% of people are born with aortic valves that have only two cusps (bicuspid valves). Although bicuspid valves usually do not impede blood flow when the patients are young, they do not open as widely as normal valves with three cusps. Therefore, blood flow across the bicuspid valves is more turbulent, causing increased wear and tear on the valve leaflets. Over time, excessive wear and tear leads to calcification, scarring, and reduced mobility of the valve leaflets. About 10% of bicuspid valves become significantly narrowed, resulting in the symptoms and heart problems of aortic stenosis.

The most common cause of aortic stenosis in patients 65 years of age and over is called "senile calcific aortic stenosis." With aging, protein collagen of the valve leaflets is destroyed, and calcium is deposited on the leaflets. Turbulence across the valve increases causing scarring, thickening, and stenosis of the valve once valve leaflet mobility is reduced by calcification. Why this aging process progresses to cause significant aortic stenosis in some patients but not in others is unknown. The progressive disease causing aortic calcification and stenosis has nothing to with healthy lifestyle choices, unlike the calcium that can deposit in the coronary artery to cause heart attack.

Rheumatic fever is a condition resulting from untreated infection by group A streptococcal bacteria. Damage to valve leaflets from rheumatic fever causes increased turbulence across the valve and more damage. The narrowing from rheumatic fever occurs from the fusion (melting together) of the edges (commissures) of the valve leaflets. Rheumatic aortic stenosis usually occurs with some degree of aortic regurgitation. Under normal circumstances, the aortic valve closes to prevent blood in the aorta from flowing back into the left ventricle. In aortic regurgitation, the diseased valve allows leakage of blood back into the left ventricle as the ventricular muscles relax after pumping. These patients also have some degree of rheumatic damage to the mitral valve. Rheumatic heart disease is a relatively uncommon occurrence in the United States, except in people who have immigrated from underdeveloped countries.

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See what others are saying

Comment from: joe, 45-54 Female (Patient) Published: March 04

I had a lot of radiation and chemotherapy and I just had a mechanical valve put in and they say they think it had some effect on my heart causing aortic stenosis, but they can't say for sure. I also had 4th stage Hodgkin's lymphoma and was treated in 1984 when the treatments were worse by far than they are now.

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Comment from: MaryAnne, Female (Patient) Published: February 19

I am 69 years old. I see an endocrinologist every 3 months for osteoporosis and thyroid. In 9/2014 I went on HCTZ (hydrochlorothiazide) for blood pressure. In 12/14, 3 months later, I was diagnosed with moderate aortic stenosis (AS). No doctor will tell me that taking calcium 500 mg and foods fortified with calcium adds to taking a large amount as a supplement. On the news it was reported that studies showed that taking calcium supplement causes heart attacks and problems. My endocrinologist said not to stop taking the calcium. I had been taking 1200 to 1500 mg calcium, mostly fortified foods (almond milk, breads, and orange juice) and 500 mg calcium pill, also in the 3 months I was on HCTZ. Heart doctor told me that that my endocrinologist should have in 9/14, noticed the AS murmur. AS does not happen in 3 months' time.

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