Pulmonic stenosi

Pulmonic stenosis: Symptoms, Causes, and Diagnosis

Introduction

The pulmonary valve controls the blood flow from the heart’s right ventricle to the pulmonary artery. Pulmonic stenosis is when the pulmonary valve among the right ventricle becomes stiff or narrow. A pulmonary artery transfers blood from the heart to the lungs. Stenosis occurs if the flaps of valves are fused or become stiffed and thickened. The narrowed pulmonary valves block the blood flow within the pulmonary arteries. 

Symptoms of pulmonic stenosis:

The signs and symptoms of pulmonic stenosis differ depending upon the blockage of blood flow. Pulmonic stenosis can be mild to an extreme level. Some patients with mild pulmonic stenosis have no symptoms. Patients with severe pulmonic stenosis may have severe signs. These are the symptoms of pulmonic stenosis, which include: 

  • Fatigue (Extreme tiredness)
  • Chest pain
  • Breathing difficulties 
  • Fainting (dizziness or unconsiousness)
  • Heart palpitations (rapid heartbeat)
  • Swollen abdomen
  • Weight gain
  • Low energy
  • Cyanosis (turns skin blue) in newborns

Causes:

Generally, pulmonic stenosis evolves before birth and accounts for about 10% of total congenital heart disease. The actual cause of pulmonic stenosis is unclear. A pulmonary valve is not developed perfectly when the baby grows in the womb. Furthermore, the valve comprises thin tissues known as flaps or cusps. The flaps open and shut within each heartbeat to manage the blood flow. In pulmonic stenosis, flaps fused and thickened, resulting in valve narrowing. The opening of smaller valves makes it hard for blood to flow from the right ventricle of the heart. The pressure in the right ventricle increases when it forces the blood to move from the smaller valves. This enhanced pressure can form a strain within the heart, causing the right ventricle valve to become stiff or thick. 

Diagnosis:

The diagnosis of pulmonary stenosis is initiated with the patient’s medical history and disease symptoms. Visit the doctor immediately if you have breathing difficulties, fainting, and chest pain. The cardiologist listens to the heart murmur using a stethoscope and recommends some tests. These tests are as follows:

  • Electrocardiogram (ECG): This quick test detects electrical signals and the heart’s rhythm. Sensors (electrodes) are attached to the chest at different points to examine heart conditions. Wires with electrodes are connected to the computer that displays the ECG results. Furthermore, ECG shows the heartbeats and detects the symptoms of muscle thickening in the heart.
  • Echocardiogram: Echocardiogram is used to check heart conditions. It creates images of the heart using sound waves and shows the heartbeats and blood flow. An echocardiogram reveals the structure within a pulmonary valve and the severity of narrowed valve. 
  • CT scans: CT scans and X-rays give more detailed images of the heart, arteries, and valves and detect pulmonic stenosis. 
  • Cardiac catheterization: A thin tube is inserted in the groin and guided through the blood vessel to the heart during this procedure. Doctors use this procedure to estimate the pressure in the heart chambers and evaluate blood flow. 
  • Cardiac MRI uses radio waves and magnetic fields to create detailed pictures of the pulmonary valve and diagnose pulmonary stenosis. 
  • Stress test: This test, often called an exercise test or treadmill test, helps to diagnose pulmonic stenosis and other heart disorders. 

Treatment :

Mild pulmonic stenosis patients require only occasional monitoring from a specialist. Severe or moderate pulmonic stenosis patients may need heart surgery or other procedures. Heart surgery depends on the appearance of the pulmonary valve. Heart procedures or surgery is used to treat pulmonic stenosis, which may include:

  • Balloon valvuloplasty: It is a non-surgical procedure used to prevent the symptoms of pulmonic stenosis and enhance blood flow from the heart. A specialist inserts a thin tube with the balloon in the groin. The balloon is channeled with a catheter into the narrowed valve within the heart. X-ray is used to monitor the balloon’s position in the narrow valve. Doctors use this procedure to repair pulmonic stenosis in adults; it decreases the symptoms and improves the blood flow.
  • Pulmonary valve replacement: When balloon valvuloplasty does not work, the catheter procedure or heart surgery is commonly used to replace a pulmonary valve. Patients with pulmonary valve replacement require antibiotics before surgery or dental procedures to reduce endocarditis. 

Risk factors:

These are the risk factors of pulmonic stenosis, such as

    • Rheumatic fever: Strep throat complications may damage the heart permanently. Rheumatic fever enhances the risk factors of pulmonary stenosis. 
  • Carcinoid syndrome: The cancerous tumor secretes chemicals in the bloodstream, causing flushing, breathing difficulties, and other symptoms. Carcinoid heart disease evolved from carcinoid syndrome in some patients and damages the heart valves. 
  • Noonan syndrome: Noonan syndrome stops the normal development of different body parts. It may cause other disorders with the structure or function of the heart.
  • Rubella (German measles): Rubella during pregnancy enhances the risk factors of pulmonic stenosis within the baby. 
  • Radiation in the chest: Patients may feel radiation in the chest is also a risk factor for pulmonary stenosis. 

Complications of pulmonic stenosis:

Pulmonic stenosis patients may face several complications, such as

  • Infective endocarditis: Pulmonic stenosis patients have higher risk factors of bacterial endocarditis that affects the heart’s lining.  
  • Arrhythmia (irregular heartbeat): Pulmonary stenosis patients have an arrhythmia or irregular heartbeats. These irregular heartbeats are not life-threatening when the pulmonary stenosis is not severe. Furthermore, the other arrhythmia symptoms are chest pain, dizziness, fatigue, lightheadedness, breathing difficulty, and anxiety. 
  • Heart failure: Heart failure develops when the heart’s right ventricle does not appropriately pump the blood. Heart failure symptoms and signs are breathing difficulties, fatigue, persistent cough, irregular heartbeat, and swelling in the abdomen and legs.
  • Pregnancy complications: Pulmonic stenosis patients have many severe complications during pregnancy. 
  • Thickened heart muscle: The heart’s right ventricle pumps the blood hardly in the pulmonary artery during severe pulmonic stenosis. A strain within the heart may cause the ventricle’s muscular wall to thicken or stiff. This condition is referred to as right ventricular hypertrophy, and its symptoms are heart palpitations, dizziness, chest pain, and breathing difficulty. 

Prevention:

A doctor recommends a healthy lifestyle to treat the signs and symptoms, thereby reducing the risk factors of pulmonic stenosis. These preventive measures may include:

  • Quitting smoking
  • Taking a nutritious diet
  • Eating more vegetables and fruits and low-fat products
  • Daily exercise
  • Maintaining weight

References:

https://www.mayoclinic.org/diseases-conditions/pulmonary-valve-stenosis/symptoms-causes/syc-20377034 

https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/pulmonary-valve-stenosis# 

https://kidshealth.org/en/parents/pulmonary-stenosis.html 

https://www.ucsfbenioffchildrens.org/conditions/pulmonary-artery-stenosis

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