Date: May 1st, 2010
Aortic stenosis is a type of heart disease where the aortic valve becomes narrowed over time, obstructing blood flow to the body. It is more common with age and if left untreated, can lead to heart disease, significantly decreased quality of life, heart failure, and even death. Fortunately, aortic stenosis (AS) can usually be treated with surgery in patients of all ages.
Despite the fact that surgery is associated with better survival and considerable improvements in quality of life, AS is under-treated in the United States. A survey conducted by the Alliance for Aging Research shows that this may, in large part, be due to patient and physician misconceptions regarding the risks and benefits of AVR surgery. Additionally, the incorrect belief that AS symptoms are simply a normal part of getting older, also leads to under-diagnosis.
Not a "Normal" Part of Aging
As the aortic valve narrows from stenosis, the heart has to work harder and blood flow to the body is slowed down. Symptoms and heart problems from AS are related to the amount of narrowing and become more noticeable and severe as the disease progresses. While some patients with mild AS do not notice symptoms, others may experience dizziness, fatigue, heart palpitations, weakness, shortness of breath, angina, and more.
Symptoms often worsen gradually so that each day may seem hardly worse than the last. Looking back after a diagnosis, it may seem obvious that it didn’t used to be as hard to walk up a flight of stairs or go out for groceries, but for some patients it can be difficult to notice changes on a day-to-day basis. They may not realize something is wrong because they have gradually accepted the changes to their health and their quality of life.
Making things even more complicated is the fact that many older adults tend to dismiss their symptoms as a “normal part of getting older.” This isn’t uncommon with diseases of aging and is also seen with things like vision and hearing loss, depression, and memory changes. We’ve been taught to believe that with older age comes decline. We’ve seen generations before us lose their mental and visual acuity and their ability to take on tasks that require energy and stamina. We figure this is bound to be our fate as well.
But getting older doesn’t have to mean feeling worse! With most patients, surgery for AS provides an almost immediate increase in quality of life. Patients report “feeling young again” and being able to take on tasks they hadn’t tackled in years. This is why it’s so important to pay attention to our bodies and talk to our health care professionals if we notice changes or feel like things “aren’t right.”
Old Age is Not a Contraindication to Surgery
Even when it is diagnosed, AS often goes untreated. While there are some drugs that can make the symptoms of AS less severe, there are no drugs that keep the disease from getting worse or that undo damage already done. The only way to eliminate AS—as well as its impact on quality of life and high risk of sudden death—is to replace the defective valve. Aortic valve replacement (AVR) surgery can reduce or get rid of symptoms almost immediately, increase independence, improve survival, and significantly impact quality of life. Unfortunately, many older patients choose not to have AVR because of fear of surgery at an older age.
Many patients, and their physicians, inaccurately believe that surgery—especially heart surgery—shouldn’t be performed in older adults because they are more likely to die or have a long and complicated recovery. In reality, the risk of complications and death are quite low and while they do rise slightly with age, age alone is not a reason to avoid the surgery. Unless other serious diseases or conditions could complicate the surgery, almost all patients with symptoms are good candidates.
Battling the Misconceptions
The bottom line is that we all need to pay close attention to our bodies and our health, and talk to our health care professionals if things change. Doctors need to watch for and ask about symptoms of aortic stenosis and other heart disease, and encourage their older patients to speak up if they feel like things aren’t right.
To learn more about the disease, causes & risk factors, symptoms, diagnosis, and surgical options, read the Alliance’s patient guide Aortic Stenosis: Facts About a Heart Valve Disease. You can also visit the Aortic Stenosis Health Corner. Materials include videos, podcasts, and patient quizzes that tests users’ knowledge of the disease. They also highlight fairly new findings about the role of lifestyle in developing AS.