Timothy Byrne, DO, is an interventional cardiologist, director of the Cardiac Catheterization Laboratories and associate director of the Interventional Cardiology Fellowship at Banner – University Medical Center Phoenix. His office can be reached at (602) 952-0002.
Question: I have a history of a heart murmur and experience occasional chest tightness with exertion, but recently I become short of breath when I lie down for bed. What could this mean?
Answer: The symptoms you describe align with a common problem of blockage in the heart arteries known as coronary artery disease.
However, in your case, these symptoms may also be a signal for aortic stenosis, a condition characterized by narrowing of the major heart valve through which blood is pumped, often resulting in chest tightness, shortness of breath and fainting.
Given your history of a heart murmur, a clinical examination by a cardiologist to exclude a heart valve issue may be warranted. If a murmur is detected, an echocardiogram can confirm whether there is narrowing in the aortic valve and the presence of aortic stenosis.
Approximately 200,000 people develop aortic stenosis each year. Unfortunately, many are too sick to undergo conventional aortic valve replacement, which entails open heart surgery. Sadly, about 60 percent of patients die within two years of the onset of symptoms without treatment. The new Transcatheter Aortic Valve Replacement (TAVR) procedure using either the Medtronic Corevalve or Edwards SAPIEN valve provides a therapy option to those who would otherwise go untreated.
Use of the Corevalve is limited to patients and medical facilities participating in a clinical trial, whereas the SAPIEN valve recently became commercially available.
The Cavanagh Heart Center at Banner – University Medical Center Phoenix became the first facility in the Southwest to perform the TAVR procedure in April 2011.
The hospital is one of few medical facilities in the country to offer both the Corevalve and SAPIEN options. While both serve essentially the same purpose, they vary in terms of valve size and composition.
Many factors dictate eligibility for valve replacement surgery and device options. Seek an evaluation by your cardiologist to determine if your symptoms are related to aortic stenosis and whether you are a candidate for valve replacement using the Corevalve or SAPIEN device.