Dizziness, fatigue and my heart
Jacob Green, MD, is an interventional cardiologist on staff at Banner Heart Hospital in Mesa, Ariz. His office can be reached at (480) 835-6100.
Question: I get fatigued, dizzy and short of breath with even light exercise and activity. Should I be worried about my heart?
Answer: What you describe could be a heart condition like congestive heart failure or coronary artery disease, which is blockage in the arteries of the heart. However, your symptoms are also classic of valvular heart disease, more specifically a condition called aortic stenosis.
A diagnostic workup, includin g review of your overall health and family history followed by an echocardiogram (ultrasound of the heart) to evaluate cardiac structure and valvular structure and function is recommended. Testing may reveal a weakened heart, which occurs for many reasons, or significant narrowing of the aortic valve, the outlet through which blood leaves the heart.
Some individuals are born with structural abnormalities of the aortic valve, but degenerative deterioration is more common, particularly among the elderly. Thickening and calcification of valve leaflets develops over time, which may hinder the valve from opening properly and create narrowing of the opening. As it narrows, the heart strains to push blood out, and blood supply becomes impaired.
Since aortic stenosis is a mechanical heart problem for which medication has proven ineffective, it must be corrected by replacing the aortic valve. This typically requires open heart surgery, but many elderly patients are not surgical candidates due to advanced age and coexisting illnesses. As it is a progressive condition, prognosis for such individuals is dismal. Fortunately, advances in technology have led to innovative new treatments.
Patients at exceptionally high risk for complications from surgical valve replacement may be candidates for transcatheter valve replacement. Pioneered in 2002, this minimally invasive approach gained FDA approval in 2011, after years of clinical research. Banner Heart Hospital is one of a handful of hospitals selected to use this new technology.
Those who have been evaluated by qualified cardiologists and cardiac surgeons and are deemed ineligible for surgical valve replacement may qualify for transcatheter valve replacement.
It requires only a small surgical incision in the groin and uses a catheter inserted in the femoral artery to deliver the valve to the heart. Patients receive general anesthesia, but the heart is not stopped and they are not placed on a bypass machine. Recovery usually takes only a few days in the hospital, and patients are up and walking the next day.
Surgical valve replacement remains the gold standard in treating aortic stenosis. Transcatheter valve replacement is not considered superior to surgical replacement, but rather equivalent in treating patients who are at higher than average risk for surgery and have no other viable option.