Dr. Vishnu S Mulchandani

A heart attack occurs when the flow of blood to the heart is blocked, often by a buildup of fat, cholesterol, and other substances, forming a plaque in the arteries. If blood flow is not restored quickly, the section of heart muscle begins to die, starving for oxygen. This causes a heart attack. A heart attack can also be caused by the rupture of the coronary artery. During a coronary rupture, the coronary arteries get restricted, reducing blood supply to the heart muscle.

Each coronary artery supplies blood to a region of the heart muscle.

Extent of damage to the heart muscle depends on the area supplied by the blocked artery and time between injury and treatment. Making some changes in your diet; how consistently you exercise; how much you weigh and how you manage stress can help you to recover from a heart disease quickly.

The heart is a wonderfully designed pump that takes care of proper functioning of the body. There are two separate channels, through which pure and impure blood flows through. Blood flow in these two designated networks is one-sided completely and controlled by valves. There are 2 sets of valves as below:

1. Aortic and pulmonary valves which controls blood flow from the ventricles to the aorta and to the lungs respectively
2. The mitral and tricuspid valves control blood flow from the atria (upper chambers) to the ventricles (lower chambers).

These valves are meant to be elastic and fibrous and open and close freely to allow for blood flow. Due to various reasons, they can become stenosed (hard and narrow) and depending on which valve is affected, complications arise accordingly.

The aortic valve is extremely important in that its proper functioning ensures that pure, oxygenated blood reaches various parts of the body. Due to various reasons, this valve may not open and/or close properly. Some causes include calcium deposits, advanced age, rheumatic fever, endocarditis, etc. With age or deposits, the valve opening can become narrow and reduce the amount of blood flowing into the aorta. The following symptoms and complications arise out of this.

1. The heart needs to put extra pressure to pump out blood into the aorta
2. The left ventricle therefore grows thicker
3. The symptoms will take a long time to manifest, as the heart will work on alternate measures, but after a certain point, symptoms will show up including chest pain, fatigue with minimal exertion, shortness of breath, and racing heartbeats.
4. As the heart has its own compensating mechanisms, symptoms show up when the condition is much serious. Therefore, onset of these symptoms requires immediate medical attention.

Diagnosis: This could be diagnosed with routine medical exam when the heart is being checked or it could only be diagnosed when the symptoms are seen as above. Treatment is easier in the earlier case, and requires more rigorous attention.

Management: If the stenosis is mild and was detected on routine exam, then it needs to be monitored periodically. Surgery is usually not done, unless it is very severe. However, preventive measures can be taken including

1. Avoiding over-exertion
2. Heart-healthy diet can be taken to prevent further damage
3. Reduce sodium intake
4. Quit smoking

If the stenosis is severe, then surgery is the only definitive treatment measure. Valve surgery can be either a

1. Balloon valvuloplasty – the valve opening is enlarged
2. Replacement – valve replacement is usually done as an open heart surgery.

Though aortic stenosis is a serious condition, it is also rare and can be managed by adopting an overall healthy lifestyle.