The term stenosis — from a Greek word meaning “to narrow” — refers to the narrowing of a passage or opening in the body. Stenosis of the aortic valve, which regulates the flow of blood from the heart to the rest of the body, can be serious. Left untreated, severe aortic stenosis can lead to heart failure and sudden death.
The incidence increases with age, rising from just over 1% for people in their 60s to nearly 10% for those 80 and older. But exactly what causes an aortic valve to narrow — and is there any way to prevent the problem from developing or progressing?
“In the United States, the most common cause is a buildup of scar tissue and calcium deposits on the valve, known as fibrocalcific aortic valve disease,” says Dr. Yee-Ping Sun, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital. Calcium — the most abundant mineral in the body — is stored mostly in your bones and teeth. But calcium is transported in the blood, and it can accumulate in both the valves and the arteries of the heart. However, calcium deposits in the heart don’t appear to be connected to the amount of calcium you consume from either foods or supplements, says Dr. Sun.
In addition to age, a range of other factors can affect if and when a person develops aortic stenosis. One is a condition present at birth that is often not discovered until the person reaches middle age or older (see “What is a bicuspid aortic valve?”). Another, less frequent cause is rheumatic heart disease, a complication of an untreated strep throat infection that, over time, damages a person’s heart valves. Today, rheumatic heart disease is rare in the United States, although it still occurs in some people, such as older adults who had strep throat during childhood before antibiotics were available or commonly accessible.
Certain health problems may increase a person’s odds of aortic stenosis, including kidney disease, hyperparathyroidism, and inflammatory disorders such as rheumatoid arthritis, lupus, and systemic sclerosis. Having radiation therapy to the chest, usually done to treat lymphoma, is another risk factor.
Elevated blood levels of a fatty particle called lipoprotein(a), or Lp(a), also appear to contribute to aortic stenosis. Lp(a) particles are like the better-known LDL cholesterol particles, but with an extra protein attached. Currently, doctors don’t routinely measure Lp(a) when evaluating people for aortic stenosis, but that may change with advancements in our understanding of Lp(a) and ways to treat it, says Dr. Sun.
|What is a bicuspid aortic valve?Heart valves consist of strong, thin flaps of tissue called leaflets or cusps. A normal aortic valve has three leaflets, but about one person in 100 is born with an aortic valve that has only two flaps. Known as a bicuspid aortic valve, this defect is two to three times more common in males than females and may run in families.”If one of your parents or a sibling has a bicuspid aortic valve, your risk of the condition is between 5% and 10%,” says Dr. Yee-Ping Sun, assistant professor of medicine at Harvard Medical School. A two-leaflet valve is more prone to calcium buildup, so people with bicuspid valves can develop aortic stenosis in their 50s and 60s — more than a decade earlier than those with normal, tricuspid valves.|
Aortic stenosis diagnosis
Aortic stenosis can cause shortness of breath, fatigue, and lightheadedness, especially when you’re physically active. But these common symptoms have many possible causes, so they’re not very helpful for pinpointing the problem. Fainting, as well as chest tightness or discomfort, can also occur. Sometimes aortic stenosis is discovered when a doctor hears an abnormal heart sound through a stethoscope; the blood flow through the narrowed valve is turbulent, creating a sound that’s initially loud and then quieter, known as a crescendo-decrescendo murmur. But increasingly, aortic stenosis is found during an ultrasound of the heart (echocardiogram) done for another reason, says Dr. Sun.
Unfortunately, there are no strategies to prevent the progression of aortic stenosis. If an echocardiogram reveals only mild stenosis, your doctor may recommend a repeat ultrasound every three to five years. Moderate stenosis should be checked every year. Once you start experiencing symptoms from severe aortic stenosis, you need a new aortic valve. For many people, including those with bicuspid valves, surgery is the best option. But a less invasive, nonsurgical approach called transcatheter aortic valve implantation is an option for increasing numbers of patients.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)
And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)
“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)
Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)
The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)
And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)
Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)
The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)
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