Every time Alison Banayoti races up the stairs or takes a long stroll, she silently expresses gratitude for the fortunate diagnosis that most likely saved her life.
Alison, a 61-year-old hospital administrator from Haywards Heath, West Sussex, has aortic valve stenosis, a narrowing or stiffness of the heart’s aortic valve.
The valve, which opens and closes over 100,000 times per day, keeps blood flowing from the heart’s primary pumping chamber, the left ventricle, to the aorta, the body’s largest blood conduit.
If the valve fails to function properly, it can deprive essential organs, muscles, and tissues of oxygen, resulting in vertigo and shortness of breath.
Untreated aortic stenosis can lead to potentially deadly heart failure, a condition in which the heart, unable to pump blood adequately, wears out from the pressure of maintaining circulation.
Now, study indicates that up to 300,000 people in the United Kingdom may have the potentially fatal illness without being aware of it.
According to research conducted by NHS England, UK universities, and the University of Notre Dame in Fremantle, Australia, the majority of patients will have no symptoms and will not be diagnosed until the disease has progressed to a point where half will die within five years without prompt treatment.
The findings, which were published in the journal Open Heart, have alarmed experts. One in 100 persons in the United Kingdom are affected by the illness, and an estimated 300,000 have severe aortic stenosis, which kills one in two in just two years.
The director of policy for the non-profit Heart Valve Voice, Callum Ferguson, argues that the data is quite alarming.
‘In any case, awareness of the warning signs of aortic stenosis – dyspnea, dizziness, and fatigue — is quite low. Some patients mistake them for indicators of ageing or inactivity. Others do not exhibit symptoms.
Heart Research UK’s Kate Bratt-Farrar concurs, stating, “We’re concerned by this research,” but adds, “This is the first step toward a clearer knowledge of the future treatment capacity necessary for aortic stenosis.”
Heart wear and tear is the most common cause of aortic stenosis, which often affects those over the age of 65.
Dr. Maurice Pye, a senior cardiologist at York Hospital, explains that when the constriction is modest or moderate, the heart compensates and there are no symptoms. “By the time symptoms such as chest tightness, heart palpitations, shortness of breath, and chest discomfort manifest, the disease is already well advanced,” he explains.
When a doctor listens to the heart for another reason and hears a murmur, it is only detected when it is mild or moderate.
A cardiac murmur may suggest improper blood flow from the heart and a defective aortic valve. The turbulent blood flow produces a ‘whooshing’ or’swishing’ sound, in contrast to the smoother sounds of blood flow in a healthy heart.
Dr. Pye adds, “The condition is unlikely to be missed once you are examined by a cardiologist, as he or she will listen to your heart and detect the murmur, as well as arrange a cardiac ultrasound [echocardiogram] that would definitively diagnose it.”
The standard treatment for aortic stenosis is either open-heart surgery to replace the valve or a less invasive method (called TAVI) in which the valve is operated on via a blood artery in the thigh or chest.
However, it is not usually the elderly that are affected: Alison was diagnosed in her forties.
She explains, “I was usually active and healthy, but at the age of 43, I had a strange turn of events.” I felt rubbery and woozy on my right side.
Alison’s primary care physician referred her to the hospital for an echocardiography, a scan that uses soundwaves to create an image of the heart, which likely saved her life.
The scan indicated that Alison was born with only two ‘cusps’ or flaps on her aortic valve, as opposed to the typical three.
The flaps are used to allow blood to leave the heart. Due to the absence of a flap, it was more difficult for her heart to pump the correct amount of blood through the valve and into the aorta with each beat.
The scans also revealed that her aortic valve was constricted. She was identified as having aortic stenosis.
Alison, however, experienced none of the typical symptoms.
She explains, “I would have never discovered I had the illness if it weren’t for the fact that I had a weird turn and was brought to a cardiologist by mistake.” “I was extremely fortunate.”
After the diagnosis, Alison, who is married to Amer, a 63-year-old retired general practitioner, underwent annual heart scans. In addition, she was prescribed five pills, including a statin, a betablocker (used to reduce the heart rate and relieve pressure), and a blood thinner.
But in 2018, when she was 57, things suddenly deteriorated.
She admits, “I felt fatigued just climbing the stairs.” Then I began to feel out of breath. I did not have chest discomfort, but I was dizzy. I believed that my shortness of breath was a result of ageing.
However, her doctor determined that her aortic stenosis had deteriorated and that she required aortic valve replacement. She was informed she had a 50/50 chance of surviving two years without it.
She writes, “Although it was heartbreaking news, I counted my blessings that it was discovered in time.”
After the onset of symptoms, replacement surgery must often be performed within 12 to 18 months.
In a four-hour open-heart surgery at St. Thomas’ Hospital in London, her aortic valve was replaced with one manufactured from human valve tissue provided by a donor.
Alison states, “When I returned, I immediately observed a difference.” I was able to take a full, deep breath for the first time in a very long time. I was on morphine and had a scar running across my chest, but I felt incredibly grateful to be alive.
She has returned to work and is loving life, and her medication has been lowered to a beta blocker.
She abseiled down St. Thomas’ Hospital for charity six months later, enjoys long walks with her dog, and is learning to swim.
She says, “The operation gave me a new lease on life.” Without the initial diagnosis in my forties, I never would have guessed that it was this ailment, or that it existed.
She says, “It made me realise that many others have it but will not know until it is too late.”
GPs could discover asymptomatic individuals through routine stethoscope examinations, according to Callum Ferguson, because to the high prevalence of ailment among those over 65.
He adds, ‘Anyone experiencing aortic stenosis symptoms must visit their primary care physician promptly and request a stethoscope examination of their heart.
Early detection is crucial, thus a simple stethoscope examination could potentially save their life.
