How does calcification develop?
For a long time, calcification was thought to be a simple wear and tear of the valve, but today it is considered an active process similar to atherosclerosis. Lipids accumulate in the valve, chronic inflammation occurs, some of the cells acquire the properties of bone and begin to deposit calcium. The valves thicken and become rigid. First, this is valve sclerosis without disruption of blood flow, then stenosis of varying degrees is formed. A separate situation is calcification of the mitral annulus, which often prevents the valves from closing and causes regurgitation.
- Sclerosis of the valves - compaction without narrowing
- Mild, moderate and severe aortic stenosis
- Mitral annulus calcification
- Accelerated calcification in bicuspid aortic valve
- Rapid progression in chronic kidney disease
Causes and risk factors
The main factor is age: after 65 years, sealing of the valves is found in a significant proportion of people. But the speed of the process depends on vascular risk factors that can be influenced. Arterial hypertension and high cholesterol accelerate calcium deposition; smoking and diabetes mellitus increase inflammation in the valve. A separate group consists of people with a congenital bicuspid aortic valve: their stenosis develops decades earlier. In severe kidney disease, the exchange of calcium and phosphorus is disrupted, and the valve calcifies faster.
- Age
- Arterial hypertension
- High cholesterol
- Smoking
- Diabetes mellitus
- Chronic kidney disease and dialysis
- Bicuspid aortic valve
- Past rheumatic fever
Symptoms
While the narrowing is small, there are no complaints, and the person lives an ordinary life. The classic triad of severe aortic stenosis is dyspnea on exertion, angina, and syncope. Often symptoms increase unnoticed: a person walks less, rests more, and explains this by age. That is why not only the complaint is important, but also an objective assessment on EchoCG. The appearance of any of the three classic symptoms with proven severe stenosis is a signal that surgery cannot be postponed.
- Shortness of breath and fatigue on exertion
- Pressing pain behind the sternum
- Dizziness and fainting during exercise
- Heart palpitations and interruptions
- Swelling of the legs with the development of heart failure
- Heart murmur upon auscultation
Diagnostics
The main method is echocardiography: it shows the thickness and mobility of the leaflets, the degree of calcification, the area of the opening, the pressure gradient and the work of the heart muscle. Using these numbers, the doctor determines the degree of stenosis and the interval for re-examination. An ECG reveals left ventricular hypertrophy and rhythm disturbances. Additionally, lipid profile, renal function and calcium levels are assessed. Before the planned operation, a CT scan with an assessment of the valve calcium index and coronary angiography are performed to simultaneously assess the condition of the coronary arteries.
- Echocardiography is the main method
- ECG
- Lipid profile, glucose, creatinine
- Stress tests - only at the discretion of the cardiologist
- CT scan of the heart before surgery
- Coronary angiography when planning surgery
Treatment and observation
There are no medications that dissolve calcium in the valve, and dietary supplements are useless here. The treatment consists of two parts. The first is control of risk factors: normal blood pressure, target cholesterol, smoking cessation, diabetes compensation, treatment of kidney disease. The second is regular echocardiography, the frequency of which depends on the degree of stenosis: from once every few years for mild to every 6-12 months for severe. For severe stenosis with symptoms, valve replacement is performed - open surgery or transcatheter implantation of the prosthesis. The decision is made by a team of cardiologist and cardiac surgeon.
- Controlling blood pressure and cholesterol
- Smoking cessation, diabetes compensation
- Moderate physical activity as agreed with your doctor
- Regular echocardiography at the appointed time
- Valve replacement for severe symptomatic stenosis
- Prevention of infective endocarditis and dental care
