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How does aortic stenosis affect the left ventricle pump?
Symptoms and heart problems in aortic
stenosis are related to the degree of narrowing of the aortic
valve area. Patients with mild aortic valve narrowing may experience
no symptoms. When the narrowing becomes significant (usually greater
that 50% reduction in valve area), the pressure in the left ventricle
increases and a pressure difference can be measured between the
left ventricle and the aorta. An easy way to conceptualize the size issues is to think of a normal aortic valve as being about a "half-dollar" size in diameter, and a significantly narrowed valve to be less than a "dime" in size. To compensate for the increasing
resistance at the aortic valve, the muscles of the left ventricle
thicken to maintain pump function and cardiac output. This muscle
thickening causes a stiffer heart muscle which requires higher
pressures in the left atrium and the blood vessels of the lungs
to fill the left ventricle. Even though these patients may be
able to maintain adequate and normal cardiac output at rest, the
ability of the heart to increase output with exercise is limited
by these high pressures. As the disease progresses the increasing
pressure eventually causes the left ventricle to dilate, leading
to a decrease in cardiac output and heart failure.