Jeff Bolash has lots he wants to accomplish this year. He plans to exercise more. He has some gardening on his to-do list. And he looks forward to doing it all without being short of breath.
Last year, Jeff learned he had aortic stenosis, a type of heart valve disease. His sleep specialist and pulmonologist, Vicky Seelall, MD, detected an irregular heart sound, or heart murmur, during a routine exam and referred him to Summit Health’s Cardiology team for further evaluation.
Jeff remembers thinking “heart murmur” was too subtle a term, given what he eventually learned about his condition. “This was serious,” he says.
Aortic stenosis explained
Aortic stenosis happens when the aortic valve in the heart becomes narrowed. This narrowing reduces blood flow from the heart to the rest of the body, and it makes the heart work harder than it should. This disease can cause heart damage and serious health problems; severe cases can lead to death.
Aortic stenosis affects mainly older adults, occurring in about 1 in every 5 people over the age of 65. Age-related aortic stenosis is often due to a calcium buildup in the valve.
Symptoms of aortic stenosis can include:
- Chest pain
- Feeling dizzy, weak, or fainting with activity
- Heart palpitations, or a fluttering, racing, or pounding heartbeat
- Shortness of breath
People with aortic stenosis usually won’t experience noticeable symptoms until the disease is advanced. For 72-year-old Jeff, one symptom stood out. “I couldn’t walk 50 feet without huffing and puffing,” he recalls.
A team-based diagnosis
Jeff first met with cardiologist Randy Cohen, MD, for a physical exam and to discuss his symptoms. Dr. Cohen also performed an echocardiogram, a test that uses sound waves to create a picture of the inside of the heart.
Dr. Cohen then teamed with Aaron Horne Jr., MD, to pinpoint the severity of Jeff’s condition and determine treatment options. Dr. Horne is a structural and peripheral cardiologist whose clinical focus is older adults, including those with aortic stenosis.
“Jeff’s echocardiogram data was borderline, but his symptoms were compelling,” says Dr. Horne, who performed a cardiac catheterization (cath) test to check for artery blockages and confirm Jeff’s disease stage.
“The cath test helps as a tiebreaker,” Dr. Horne continues. “It showed that Jeff’s aortic stenosis was more severe.” Dr. Horne says that without treatment, survival rates for severe symptomatic aortic stenosis are 50% only two years after symptoms begin.
Aortic stenosis treatment: a newer, less invasive option
Given Jeff’s age and disease severity, Dr. Horne recommended a transcatheter aortic valve replacement (TAVR), a minimally invasive alternative to open-heart valve replacement surgery. Currently, Dr. Horne is the only Summit Health cardiologist performing this procedure.
During a TAVR procedure, a cardiologist inserts a thin, flexible tube (catheter) into an artery and guides it to the heart. Next, a replacement valve made of cow or pig tissue is passed through the catheter to the aortic valve. The replacement valve expands inside the old valve, the catheter is removed, and the small incision made for the catheter is closed.
Jeff received moderate sedation for his procedure, which took about an hour, and stayed overnight at the hospital. “Being serious as it was, it was very easy,” he says. “Dr. Horne had a good bedside manner and was easy to talk to.”
While no procedure is without risks, TAVR has advantages over open-heart surgery. These include less pain, shorter hospital stays, easier recovery, and better outcomes. “It’s one of the most fulfilling procedures I do,” says Dr. Horne. “It changes patients’ lives.”
“I’m looking forward to doing more things now,” says Jeff. “Before, it was hard to get out of bed.”
Heart health and older adults
TAVR patients will need regular check-ups to ensure their replacement valve continues to work as it should. In the meantime, making heart-healthy lifestyle choices can help. These include:
- Managing your diet
- Maintaining a healthy weight
- Exercising regularly
- Quitting smoking
Dr. Horne believes raising aortic stenosis awareness among older adults is important. “When we start slowing down, we assume it’s a by-product of age, but sometimes that’s not solely the case,” he says. “We want to make people more aware of valve disease symptoms and how we can be a resource.”