The aortic heart valve allows for the unidirectional ejection of oxygenated blood from inside the heart (left ventricle) to the systemic circulation. Adequate functioning of the aortic valve is dependent on its complete opening, which allows the unobstructed passage of blood, and tight closure (after ejection of blood) which prevents back flow into the heart. The progressive narrowing of the aortic valve is referred to as aortic stenosis (AS).
 
Causes include:
 

•	Rheumatic Heart Disease (secondary to rheumatic fever)
•	Congenital Defects (bicuspid valve): found in up to 2% of the general population
•	Idiopathic Sclerosis (scarring of the aortic valve in the elderly that occurs for unknown reasons)

The principal problem with aortic stenosis is obstruction to blood flow. Those with rheumatic heart disease, or bicuspid valve, can develop the symptoms of AS most commonly between the age of 40 and 60. With an increase of obstruction to blood flow (through the stenotic valve), the heart attempts to compensate by enlarging. Eventually, the heart begins to decompensate and the patient will develop symptoms consistent with aortic stenosis.
 
Symptoms include:
 

•	Shortness of breath, especially with exercise
•	Fainting, especially with exercise
•	Chest pain
•	Heart palpitations

Advanced AS patients may develop congestive heart failure and cardiac arrhythmias (atrial fibrillation).
 
Diagnosis:
Evaluation of suspected AS will include: ECG, Chest X-Ray, and echocardiogram. Some patients may require cardiac catheterization prior to surgical correction of the diseased valve.
 
Treatment:
Treatment will consist primarily of artificial heart valve replacement in those who develop more significant symptoms. Salt restriction, diuretic therapy (furosemide), and digoxin are also effective. Strenuous exercise should be avoided. Those with atrial fibrillation may require medications to control the rate, and blood thinning medications (warfarin) to decrease the risk of stroke.
 
The Cardiologist is the expert in the evaluation of this problem.