DEAR DR. GOTT: I have just been diagnosed as having severe aortic valve stenosis. I am 95 years old with normal cholesterol and blood pressure readings and am generally in good health. I want to do something more efficacious than to just “wait and see”. I have a family doctor but need your very valuable second opinion and ask that you address the following concerns of mine.
At my age, I fear the result of any surgery would be negative. Is that true? Would you recommend the less-invasive balloon procedure? Can you recommend an exercise program to strengthen the heart and aortic valve to keep the blood flowing through the narrowing opening? Since the problem arises from calcium deposits on the aortic valve, would you recommend I stop taking calcium supplement tablets and my Actonel?
Thank you for addressing these issues.
DEAR READER: Congratulations on reaching the age of 95 in otherwise seemingly good health. I will attempt to answer your questions but with access to your medical chart I can only give you generalizations.
Aortic valve stenosis occurs when the left ventricle and aorta fail to work properly. Blood becomes obstructed in the aorta, causing the heart to work harder. Calcium deposits can build up, causing stiffening of the leaflets of the aortic valve and narrowing to occur. Aortic valve stenosis doesn’t commonly appear before the age of 65, with symptoms appearing some five years later. So, at 95 you are well ahead of the norm. Left untreated, stenosis can lead to complications; therefore, a severe case is generally managed through surgery. Your cardiologist is the best judge of whether surgery is appropriate or should be held off, based on the severity of your condition and your overall general health.
Symptoms can be mild to severe and may include shortness of breath, palpitations, murmur, fatigue (primarily during exercise or activity), fainting, and chest pain known as angina. The feet and ankles may become swollen. Diagnosis is commonly made during examination by a physician after a murmur is detected, since the murmur generally precedes other symptoms.
While I can appreciate your concern over taking a calcium supplement, there is no evidence I am aware of to support the connection between excess calcium intake and the risk of degenerative aortic stenosis. Other than your Actonel, you are likely on a calcium supplement with vitamin D to keep your bones strong and fight off osteoporosis. If your physician approved of such a program with both drugsknowing about your stenosis, there is likely no contraindication and you should continue it. If, however, your primary care physician was not then or now aware of your stenosis, then it’s time for a review.
If you haven’t received appropriate answers regarding exercise vs. surgery, I recommend you make an appointment to discuss your concerns. An exercise regimen will not likely improve your condition and, in fact, may be life-threatening to those with severe aortic stenosis. However, on the other hand, I strongly feel you should remain as independent as possible and incorporate an exercise program to the fullest extent APPROVED of by those who know and follow your case.
Readers who would like related information can order my Health Report “Coronary Artery Disease” by sending a self-addressed, stamped, number 10 envelope and a $2 US check or money order payable to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
