Feeling breathless? It could be a sign of heart disease

It is not uncommon to hear elderly people say that they are feeling exhausted. Often, they chalk it up to ageing and start cutting back on their daily activities. But these seemingly common complaints can be signs of something more serious, like a heart condition.

Something similar happened with 75-year-old Deepak (name changed) who had ignored his breathlessness and tiredness as signs of old age. When he collapsed suddenly during a family vacation, doctors discovered he had aortic stenosis or narrowing of a valve in his heart. Timely treatment with transcatheter aortic valve implantation (TAVI) helped his heart pump properly.

Let’s understand aortic stenosisThink of the heart as a busy engine that keeps your body running. Inside this engine, there are four sections, or ‘rooms,’ that clean and oxygenate your blood before sending it out to the rest of your body with the help of lungs. These rooms are connected by valves, which act like doors that open and close to control the flow of blood.
One of these valves, called the aortic valve, is especially important because it lets oxygen-rich blood leave the heart and flow to the rest of your body. But sometimes, this valve can become too narrow or get blocked, making it harder for the heart to pump blood. This condition is called aortic stenosis. This puts strain on the heart and can cause damage over time.

Why is this important?Aortic stenosis is more common than you think. It is estimated that between 9.4 to 12.6 million suffer from this disease globally. However, the prevalence may be much higher as the condition is asymptomatic in many cases and remains undiagnosed. If left untreated, patients with severe aortic stenosis suffer from heart failure and may die within two to five years. Being aware of the disease and its symptoms is important to receive prompt treatment.

Things to watch out forSome underlying causes for aortic stenosis are:
* age-related wear and tear
* Congenital heart disease or other chronic conditions (e.g. diabetes, hypertension)
* Infections during childhood (e.g. chronic strep throat or scarlet fever- Rheumatic heart diseases)⁠

Common symptoms include tiredness, lightheadedness, fainting, breathing problems, swollen feet or ankles, fatigue, palpitations (rapid heartbeat), and chest pain (during exertion). These symptoms can be easily overlooked or in the case of the elderly, may be attributed to age, leading to delayed diagnosis and poorer outcomes.

Doctors diagnose the condition by listening for abnormal heart sounds or via imaging tests such as trans-thoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE).

Treatment optionsIn severe cases where the heart valve is too damaged, the only solution is to replace it. Depending on the age of the patient, overall health, and the severity of the aortic stenosis, the choice is usually between surgical aortic valve replacement (SAVR) or a less invasive procedure called trans catheter aortic valve implantation /replacement (TAVR/TAVI). Shared decision-making between clinicians and patients ensures that the treatment aligns with the patient’s values, preferences, and lifestyle. Some key aspects to be considered are given below.

* SAVR is the traditional open-heart surgery where the surgeon makes an incision in the middle of the chest to reach the heart and place the valve. This type is surgery is suited for younger patients and those without any complications.
* TAVI is a less invasive option often recommended for older patients, those with other health issues that make surgery risky, or those who are too weak. In this procedure, the doctor inserts a catheter (thin tube) through the upper thigh blood vessel to reach the heart. TAVI typically leads to faster recovery, requires shorter hospital stays, and carries fewer risks. Recent technological improvements in TAVI include the development of self-expanding valves, which are especially useful for patients with very small or small anatomy. These valves adjust themselves according to the patient’s heart and tend to last longer.

Aortic stenosis is a serious and potentially life-threatening condition. Ignoring the symptoms can lead to heart failure or sudden death. The key is recognizing the symptoms early and seeking prompt medical care. In case you or any of your family members suffer from breathlessness or episodes of fainting, reach out to the doctor immediately as this may be a sign of a deeper problem. With prompt detection and newer treatment options like TAVI, conditions like aortic stenosis can be treated effectively, offering patients healthier lives.

(Author: Dr. S. Nagendra Boopathy, Senior Consultant, Interventional cardiology, Sri Ramachandra Hospital, Chennai)