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THE heart is essentially a pump with four chambers and various “pipes” that connect it to all the organs and tissues in the body.

Within the chambers of the heart are valves that serve as conduits through which blood flows through.

One of these valves is called the aortic valve, which is responsible for regulating blood flow from the heart’s left ventricle to the rest of the body.

In the condition called aortic stenosis (AS), this valve becomes narrowed or partially blocked, which obstructs the smooth flow of blood – forcing the heart to work harder to pump blood.

 

Over time, this increased workload can lead to significant heart problems.

According to consultant cardiologist Dr Jayakhanthan Kolanthaivelu at Cardiac Vascular Sentral Kuala Lumpur (CVSKL), several factors contribute to the development of AS. The most common is age-related wear and tear on the valve.

“Generally, those who are elderly, as in 75 years and above, experience degenerative issues of the valve.

“And because the valve is so important as a ‘gate’ through which blood flows to the whole body, narrowing of the valve results in the heart working harder to push blood out into the body.

Dr. Jayakhanthan Kolanthaivelu Consultant Cardiologist

“As a consequence, the heart may swell and eventually develop some form of heart failure.

“One of the biggest problems with AS is that you can have sudden collapses because there’s not enough blood flowing out to the body, especially the brain.

“This may lead to sudden death in certain circumstances,” warns Dr Jayakhanthan.

Other risk factors include congenital heart defects, rheumatic fever, and certain genetic conditions. High blood pressure and cholesterol levels, diabetes and smoking also increase the risk of AS.

Symptoms

“Generally, when it comes to valve problems of the heart, one of the key symptoms is breathlessness,” says Dr Jayakhanthan.

“Patients may also feel more tired than usual.

“Other symptoms may include chest pain or discomfort, dizziness, and fainting. It’s essential to pay attention to these signs, especially if they occur during physical activity or exertion.”

transcathether valve replacement procedure

Early detection 

One of the challenges with AS is that it often progresses slowly, and individuals may not experience noticeable symptoms in the early stages. 

Hence, early detection of AS is crucial for effective management and improved outcomes.

Routine check-ups and cardiovascular assessments can help identify the condition in its initial stages. 

Diagnostics tests such as echocardiogram, electrocardiography (ECG), or cardiac catheterization may be recommended to assess the severity of the valve narrowing and its impact on heart function, says Dr Jayakhanthan. 

“The echocardiogram is like a ‘baby scan’ of the heart. It’s an ultrasound of the heart that is painless and easily carried out.

“Depending on the severity of the AS, other tests may be also be required,” he says.

Treatment

The treatment approach for AS depends on the severity of the condition.

Dr Jayakhanthan reveals that in mild cases, regular monitoring and lifestyle modifications may be sufficient.

“It is recommended that patients get an echocardiogram every year, unless the symptoms progress or something happens.

“For moderate to severe conditions, we monitor every six months and manage accordingly.

 

silent-threat-to-heart-health-Dr Jayakhanthan-cvskl cardiologist

“Some patients may even have more severe stenosis without any symptoms. We have to consider all factors before deciding on treatment options, looking at the risks and benefits of any intervention.

“For some, medical intervention to control symptoms may be the answer. For others, surgical options include aortic valve replacement or repair, which can significantly improve blood flow and alleviate symptoms.”

Less invasive procedures, such as transcatheter aortic valve replacement (TAVR), have become increasingly common, offering alternative options for eligible patients.

“Aortic valve replacement involves open heart surgery to replace the valve. It has been the traditional way to treat heart valve problems over the years,” Dr Jayakhanthan says.

“TAVRs have been around for about only 12 to 15 years, and it’s becoming more prevalent. Initially, it was meant for high risk patients who could not risk aortic valve replacement surgery.

“Over the years, long term data has emerged about TAVRs, and these indicate that such procedures can be very effective to treat valve problems, even in less severe AS.

“These days, there are quite a few options available, and the technology has kept on improving.”

Both surgical options have their own unique advantages and possible side effects, and which option to decide on will depend on the individual patient and the treating doctor, says Dr Jayakhanthan.

The important thing is to monitor patients closely so that a decision can be made according to the patient’s condition.

“We should optimise treatment based on their health parameters such as blood pressure, heart rate, symptoms, other illnesses and so on.

“Based on these, we can then make an informed decision about treatment and management,” notes Dr Jayakhanthan.

Lifestyle changes 

While some risk factors for AS such as age and genetics, are beyond our control, adopting a heart-healthy lifestyle can play a crucial role in prevention and management. 

A balanced diet, regular physical activity and managing comorbidities are key factors in promoting overall cardiovascular health. 

Regular check-ups depending on your age and situation, timely medical intervention, and leading a heart-friendly lifestyle are essential to maintaining good heart health and ensuring a fulfilling and active life. 

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