Aortic valve disease 2 affects the valve between the heart and the aorta and can disrupt blood flow. People with aortic valve disease 2 may have chest pain, breathlessness with activity, or fainting, and doctors may hear a heart murmur. It often progresses over years, and early symptoms of aortic valve disease 2 can be mild or absent. Older adults are most often affected, but some younger people can have it, and severe untreated disease can raise the risk of heart failure and early death. Treatment ranges from medicines to manage symptoms to valve repair or replacement, and many people do well after timely care.
Overview
Aortic valve disease 2Symptoms
Aortic valve disease 2 often shows a bicuspid aortic valve, heart murmur, or enlargement of the aorta, sometimes noted in childhood or adulthood. Features can include breathlessness, chest pain, fainting, fatigue, or palpitations from a narrowed or leaky valve.
Outlook and prognosis
Most people living with aortic valve disease 2 do well with regular follow-up, heart-healthy habits, and timely procedures when needed. Outlook depends on valve narrowing or leak severity, age, and other heart conditions. With modern care, many maintain active, independent lives.
Causes and risk factors
Aortic valve disease 2 usually stems from a change in a gene called NOTCH1, often inherited from a parent. Family history, a congenital bicuspid valve, and aging raise risk; high blood pressure, high cholesterol, smoking, and inflammation can speed calcification.
Genetic influences
Genetics play a meaningful role in aortic valve disease 2. Variants in certain genes can raise risk, influence age of onset, and affect severity. Family history matters, so relatives may benefit from heart checks and, in some cases, genetic counseling.
Diagnosis
Aortic valve disease 2 is diagnosed by clinical features on heart exam and imaging, especially echocardiogram or CT/MRI. Genetic tests and family history can confirm the diagnosis of Aortic valve disease 2 and guide care.
Treatment and drugs
Treatment for aortic valve disease 2 focuses on easing strain on the heart and restoring healthy blood flow. Many start with medicines to manage blood pressure, rhythm, and fluid buildup, while cardiologists monitor progression. When the valve causes significant narrowing or leakage, procedures like valve repair, surgical replacement, or transcatheter aortic valve replacement (TAVR) are considered.
Symptoms
Day to day, Aortic valve disease 2 can sap stamina, make breathing feel harder with activity, and bring on chest discomfort. Early features of Aortic valve disease 2 can be subtle, like tiring sooner with exercise or a new heart murmur a doctor hears. Features vary from person to person and can change over time. Some people have no noticeable issues for years and only learn about it during a routine checkup.
Many people with Aortic valve disease 2 feel well for a long time. A doctor may first notice changes during a routine exam.
Breathing may feel harder with exercise or climbing stairs. Some notice it when lying flat or waking at night.
Tightness, squeezing, or pressure can occur with activity or cold weather. Rest usually helps it settle.
Energy may dip, and everyday tasks take more effort. What once felt effortless can start to require more energy or focus.
How people usually first notice Aortic valve disease 2?
People often first notice aortic valve disease through subtle changes like shortness of breath during stairs or hills, chest pressure with exertion, unusual fatigue, lightheadedness, or fainting, sometimes accompanied by a heartbeat that feels forceful or irregular. A primary care clinician may be the first to suspect it after hearing a heart murmur with a stethoscope, leading to an echocardiogram (heart ultrasound) that confirms whether the valve is narrowed (stenosis) or leaky (regurgitation). In some, swollen ankles, reduced exercise tolerance, or waking at night short of breath prompts evaluation, especially as symptoms often appear gradually and are more noticeable with age or increased activity.
Types of Aortic valve disease 2
Aortic valve disease 2 is a genetic/congenital condition. Variants are defined by the specific gene change and can lead to different ages of onset, valve changes, and extra‑cardiac features. Not everyone will experience every type. Clinicians often describe them in these categories:
Autosomal dominant
This variant often runs in families with multiple affected relatives across generations. People may develop aortic valve narrowing or leakage in adolescence through mid‑adulthood, sometimes alongside aortic root enlargement.
Early-onset severe
Changes in this subtype tend to appear in infancy or childhood with faster valve thickening and reduced opening. Symptoms can include poor feeding, breathlessness, or slow growth, and procedures may be needed earlier in life.
Bicuspid-associated
Many living with this variant have a bicuspid aortic valve, meaning two leaflets instead of three. This can increase the chance of murmur, exercise intolerance, or chest discomfort and may come with dilation of the ascending aorta.
Conduction-involvement
In this form, the same gene change affects the heart’s electrical system as well as the valve. People may notice palpitations, lightheaded spells, or fainting, and monitoring for rhythm issues is important.
Aorta-predominant
Here the aorta is more noticeably affected than the valve at first, with gradual enlargement over time. Blood pressure control and regular imaging are central, while valve symptoms may remain mild for years.
Milder late-onset
This variant stays quiet through young adulthood and shows up later with gradual valve leakage or stiffness. For many, certain types stand out more than others.
What genetics can tell you about symptoms
Some people with Aortic valve disease 2 have NOTCH1 gene changes that disrupt valve formation, leading to early calcification, a bicuspid valve, or narrowing (aortic stenosis). Others develop leakage (aortic regurgitation) or enlarged aorta, with severity varying even within the same family.
Causes and risk factors
Aortic valve disease 2 is caused by a change in a single gene that can be inherited or can appear new at conception. This change can lead to a valve with two flaps instead of three and to early calcium buildup. Age, being male at birth, high blood pressure, high LDL cholesterol, smoking, diabetes, chronic kidney disease, past chest radiation, rheumatic fever, and valve infections can raise the chance of faster valve narrowing. Because early symptoms of aortic valve disease 2 can be subtle, knowing your family history is a good first step. Risk varies between people, and other health problems can change how quickly the valve worsens.
Environmental and biological risk factors
For families planning a pregnancy, it’s natural to wonder what environmental and biological factors could raise the chance of a baby being born with Aortic valve disease 2. Doctors often group risks into internal (biological) and external (environmental). Below are environmental and biological risk factors for Aortic valve disease 2 that act during early fetal development.
Pregnancy at age 35 or older is linked with a small increase in congenital heart defects. The absolute risk remains low, but the chance of aortic valve malformation is slightly higher.
Conception with an older father has been associated with a modest rise in some heart defects. The overall likelihood remains small for any one pregnancy.
Diabetes present before pregnancy can affect early heart development, especially around the time of conception. This raises the chance of Aortic valve disease 2 and related valve or outflow tract malformations.
High phenylalanine levels in a mother with phenylketonuria during early pregnancy can disrupt heart formation. This biological factor increases the likelihood of valve defects.
Genetic risk factors
Genetic factors play a central role in Aortic valve disease 2, most often linked to changes in a gene called NOTCH1. These changes can be inherited in families or arise for the first time in a child. Carrying a genetic change doesn’t guarantee the condition will appear. When a known change runs in a family, genetic testing for aortic valve disease 2 may help identify relatives who could benefit from heart checkups.
NOTCH1 gene changes: NOTCH1 changes are the best-established genetic cause of Aortic valve disease 2. They can disrupt how the aortic valve forms and how it calcifies over time.
Autosomal dominant inheritance: One changed copy of the gene can be enough to raise risk (autosomal dominant). Each child of a carrier has about a 50% chance to inherit the change.
Reduced penetrance: Some people who inherit the change never develop obvious valve disease. Others may show mild findings for years before narrowing appears.
Variable expressivity: The same gene change can look different in each person. In one family, someone may have a bicuspid valve while a sibling develops early calcific stenosis.
De novo changes: A NOTCH1 change can arise for the first time in a child. Parents can have normal valves and no history, yet the child has features of Aortic valve disease 2.
Family history signal: Close relatives of someone with Aortic valve disease 2 have higher odds of bicuspid aortic valve or other left-sided heart differences. This clustering points to inherited risk.
Age-related expression: Gene carriers can have a normal-appearing valve in youth, then develop calcification and narrowing later in adulthood. This pattern explains why early exams may be normal.
Known family change: When a specific NOTCH1 change is found in a family, relatives who carry it face higher risk for Aortic valve disease 2. Targeted testing can show who carries it.
Lifestyle risk factors
Aortic valve disease 2 is a genetic condition, so daily habits do not cause it, but they can shape symptom burden, rate of calcification, and risks to the aorta. Here we focus on how lifestyle affects Aortic valve disease 2 to support safer activity and slower progression. Choices that control blood pressure, inflammation, and infection risk are particularly important.
Moderate aerobic activity supports heart function and lowers afterload on the valve. High-intensity isometric efforts (maximal lifting, breath-holding) can acutely raise aortic pressure and stress a bicuspid aorta.
High-salt eating promotes hypertension, increasing transvalvular gradients and aortic dilation risk. Lowering sodium helps keep pressures down and reduces strain on the valve.
Diets high in saturated fats and ultra-processed foods can worsen LDL, which is linked to faster aortic valve calcification. Emphasizing fiber-rich foods and unsaturated fats may slow calcific changes.
Tobacco and nicotine accelerate vascular inflammation and calcification that can stiffen the aortic valve. Quitting reduces progression risk and supports better surgical outcomes if needed.
Risk prevention
Aortic valve disease 2 is usually inherited, so you can’t fully prevent it—but you can lower the chance of complications and slow changes over time. Prevention is about lowering risk, not eliminating it completely. Regular heart check‑ups and healthy daily habits help protect the valve and the rest of the heart. If this runs in your family, relatives may benefit from screening to find issues early, sometimes before symptoms appear.
Periodic echocardiograms can spot valve changes early and guide timing of treatment. Finding problems before symptoms start can prevent emergencies.
Keeping blood pressure in the target range reduces strain on the aortic valve. Work with your clinician on home monitoring and medicines if needed.
Managing cholesterol and blood sugar helps limit artery and valve inflammation. This may slow calcification that can worsen aortic valve disease.
Tobacco and vaping raise inflammation and speed vessel and valve damage. Quitting lowers progression risk in aortic valve disease.
Transmission
Aortic valve disease 2 is not contagious; you can’t catch it from someone else. It involves genetic transmission of Aortic valve disease 2 within families, and in most cases, if one parent carries the gene change, each child has a 50% (1 in 2) chance of inheriting it. Sometimes it appears for the first time in a family because of a new genetic change, even with no prior history. Features can vary from person to person, even among relatives.
When to test your genes
Aortic valve disease 2 is typically genetic, so consider testing if close relatives had early valve disease, sudden cardiac death, or unexplained fainting. Test sooner if you have a heart murmur, exercise intolerance, chest pain, or arrhythmias. Results can guide surveillance, timing of interventions, and family screening.
Diagnosis
Aortic valve disease 2 is usually picked up when symptoms or exam findings point to a valve that isn’t opening or closing as it should. For many, the first step comes when everyday activities start feeling harder. Shortness of breath, chest pressure, or lightheaded spells often lead to a check-up, followed by tests that look closely at the valve and heart function. You may need more than one test so your team can see severity, track changes over time, and plan treatment safely.
Doctors usually begin by asking about symptoms, exercise tolerance, and any fainting or chest discomfort. They also review medications and family history to spot risk patterns. This helps guide which tests are needed first.
Your provider listens for a heart murmur and checks blood pressure, pulses, and signs of fluid buildup in the legs or lungs. Findings on exam can suggest valve narrowing or leakage. They also help gauge how urgent testing should be.
An ultrasound of the heart shows valve movement and measures how tight or leaky the valve is. Doppler readings estimate pressure gradients and heart pumping strength. It is central to the diagnosis of Aortic valve disease 2.
A small probe in the esophagus provides sharper images when the standard ultrasound is unclear. This is useful before procedures or when complications are suspected. Sedation is typically used to keep you comfortable.
Stages of Aortic valve disease 2
Aortic valve disease often moves through clear stages that help doctors decide when to watch, when to test, and when to treat. In daily life, this can range from no symptoms at all to limits with climbing stairs or keeping up during a brisk walk. If you’re wondering about early symptoms of aortic valve disease, mild breathlessness with exertion or unusual fatigue may be first clues. Different tests may be suggested to help confirm the stage, with echocardiograms playing a key role over time.
Stage A
At risk: You have risk factors or a minor valve change, but the valve still works well. There are no symptoms, and everyday activities feel normal. Regular checkups track any changes.
Stage B
Progressive: The valve leak or narrowing is mild to moderate and usually found by a murmur and echocardiogram. Most people feel fine, though some notice breathlessness or fatigue with harder exercise. Periodic scans (often yearly or every few years) watch for progression.
Stage C
Severe, no symptoms: The valve problem is severe on testing, but you still feel well day to day. The heart may show strain or enlargement, signaling higher risk even without symptoms. Close follow-up helps time treatment before damage occurs.
Stage D
Severe, symptomatic: Symptoms such as shortness of breath, chest discomfort, lightheadedness or fainting, and reduced stamina are now present. Activity can become limited, and urgent evaluation is needed. Treatment—often valve repair or replacement, including transcatheter options—usually follows.
Outlook and prognosis
Looking ahead can feel daunting, but most people with aortic valve disease 2 want a clear sense of what life might look like in the years to come. Prognosis refers to how a condition tends to change or stabilize over time. Many living with aortic valve disease 2 stay active for years, especially when the valve problem is mild and blood flow remains good. If the valve narrows or leaks more over time, symptoms like breathlessness, chest pressure, lightheaded spells, or reduced exercise tolerance can creep in. Early symptoms of aortic valve disease 2 can be subtle, so catching changes with regular checkups often leads to better outcomes.
Over time, most people with aortic valve disease 2 will need closer monitoring, and some will eventually benefit from a valve repair or replacement to prevent heart strain. In medical terms, the long-term outlook is often shaped by both genetics and lifestyle. Age, other heart risks (like high blood pressure), and how quickly the valve changes all affect the path ahead. Without timely treatment for severe disease, the risks rise—fainting, heart failure, abnormal rhythms, and a higher chance of early death—while successful valve procedures can dramatically improve symptoms and survival.
With ongoing care, many people maintain good quality of life, work, travel, and exercise within personalized limits. Talk with your doctor about what your personal outlook might look like. Regular follow-up, heart-healthy habits, and prompt attention to new symptoms make a real difference in the prognosis for aortic valve disease 2. If your family has a history of valve conditions, genetic testing can sometimes provide more insight into prognosis, although not everyone with the same gene change will have the same outlook.
Long-term effects
Over years, Aortic valve disease 2 can change how the valve opens and how the nearby aorta holds up, which can affect energy, stamina, and heart strain day to day. Long-term effects vary widely, and they can progress slowly or speed up after long quiet periods. The long-term outlook for Aortic valve disease 2 is often favorable with regular follow-up and timely procedures when needed. For some, things stay stable for many years; for others, valve wear and tear builds and eventually calls for repair or replacement.
The valve opening can become tighter over time, making it harder for blood to leave the heart. This can lead to reduced exercise tolerance and chest pressure with exertion. Fainting can occur in advanced cases.
The valve may not close fully, allowing blood to leak backward and strain the heart. Over years, this can enlarge the heart and lower stamina. Swelling in the legs or breathlessness may appear when leakage becomes significant.
Calcium can build up on the valve earlier than in the general population, stiffening the leaflets. This speeds the path toward narrowing and can bring on issues at a younger age. It may be picked up on echocardiograms before daily limits are obvious.
The first part of the aorta can slowly widen, raising the risk of aneurysm or, rarely, tear. Doctors often track these as long-term effects or chronic outcomes. Regular imaging helps guide timing of care.
How is it to live with Aortic valve disease 2?
Living with aortic valve disease can feel like your body’s stamina has an unpredictable ceiling—some days you climb stairs without a thought, other days breathlessness, chest pressure, or fatigue make you slow down. Daily life often involves pacing activities, keeping up with medications, and regular checkups or imaging to track the valve’s function, with many finding that structured exercise, cardiac rehab, and good sleep make a noticeable difference. People around you may take on more practical support during flare-ups or recovery after procedures, and clear communication helps them understand that symptoms can ebb and flow. Many live full, active lives—especially after timely treatment such as valve repair or replacement—by listening to their bodies and planning ahead.
Treatment and drugs
Treatment for aortic valve disease 2 focuses on easing symptoms, protecting the heart, and deciding when to repair or replace the valve. Medicines that ease symptoms are called supportive therapies and may include diuretics to reduce fluid, blood pressure drugs, and medications to control heart rhythm, but they don’t fix a narrowed or leaky valve. If the valve is severely diseased or symptoms are getting worse—such as increasing shortness of breath, chest pressure with activity, or fainting—doctors may recommend valve replacement with open-heart surgery or a less invasive catheter procedure (TAVR), depending on your age, overall health, and valve anatomy. Treatment plans often combine several approaches, including cardiac rehab, activity guidance, and regular scans to monitor the valve and heart muscle. Ask your doctor about the best starting point for you, and how often you should be checked for early symptoms of aortic valve disease 2 getting worse.
Non-drug treatment
Daily routines can make a meaningful difference when you’re living with aortic valve disease. You may notice limits with stairs, long walks, or carrying groceries; the goal is to keep you active while protecting your heart. Alongside medicines, non-drug therapies can improve stamina, reduce strain on the valve, and help you spot changes sooner. Knowing the early symptoms of aortic valve disease—like new shortness of breath, chest pressure, or lightheadedness—also guides when to seek care.
Choose moderate, regular activity like walking or cycling and avoid heavy straining if you have significant narrowing. Short, frequent sessions are safer than sporadic intense workouts. Ask your doctor which non-drug options might be most effective for your fitness level.
Structured programs, like cardiac rehab, can help you build endurance safely and learn heart-healthy habits. Supervised exercise and education are tailored to your valve condition. Many people find non-drug therapies easier to stick with when they’re guided and tracked.
Limiting salt to about 2 grams (2,000 mg) per day can ease fluid buildup and swelling. If advised, a fluid limit of 1.5–2 liters (about 50–68 oz) can reduce breathlessness. Keep track of how lifestyle changes affect your symptoms.
Reaching and maintaining a healthy weight reduces workload on the heart. Small, steady changes in eating and activity often add up. Even small changes can lead to meaningful improvements in energy.
Your genes may have an impact on how drugs work for you
Some genes act like dimmer switches on how your body processes heart medicines, changing how quickly you activate, clear, or respond to drugs used for aortic valve disease. Because of this, two people on the same dose can feel very different effects.
Pharmacological treatments
Medicines for aortic valve disease mainly help with symptoms and protect the heart; they can’t repair a tight (stenotic) or leaky (regurgitant) valve. They can ease breathlessness, swelling, and chest discomfort, especially when early symptoms of aortic valve disease first appear. Drugs that target symptoms directly are called symptomatic treatments. Your care team may adjust doses as your blood pressure, kidney function, and valve status change over time.
Furosemide or torsemide help your body shed extra fluid to reduce leg swelling and shortness of breath. They don’t treat the valve itself but can make daily activities easier. Your team will watch blood pressure, electrolytes, and kidney function.
Enalapril, lisinopril, or losartan lower afterload and help the heart pump more efficiently, especially in aortic regurgitation. In severe aortic stenosis they’re used carefully to avoid low blood pressure. Dosing may be increased or lowered gradually to balance benefit and side effects.
Nifedipine or hydralazine can reduce the resistance the heart pumps against in aortic regurgitation. This may ease symptoms and protect the left ventricle when surgery is not yet planned.
Metoprolol or bisoprolol may help chest discomfort, fast heart rhythms, or high blood pressure in aortic valve disease. They’re used thoughtfully in advanced disease because slowing the heart too much can worsen regurgitation or drop blood pressure.
Genetic influences
Aortic valve disease 2 can have a genetic component, and in some families several relatives have valve problems such as a bicuspid aortic valve or early calcification. The inheritance often appears “autosomal dominant,” meaning each child of an affected parent has about a 1 in 2 (50%) chance to inherit the gene change, but how and when it shows up can differ from person to person. Family history is one of the strongest clues to a genetic influence. Even with a gene change, not everyone develops symptoms, and signs may emerge only with age. Genetic testing may find changes in genes that help guide valve development, but results aren’t conclusive in every family. Some people first notice a family pattern when early symptoms of Aortic valve disease 2—like a new heart murmur or shortness of breath—lead to an echocardiogram and doctors suggest screening close relatives.
Is Aortic valve disease 2 genetic?
Genetics play a meaningful role in aortic valve disease 2. Variants in certain genes can raise risk, influence age of onset, and affect severity. Family history matters, so relatives may benefit from heart checks and, in some cases, genetic counseling.
Pharmacogenetics—how genetics influence drug effects
Care for Aortic valve disease 2 often includes medicines before and after valve procedures, and your genes can influence how well some of these drugs work or what dose is safest. The gene changes that raise the risk of Aortic valve disease 2 mostly affect how the valve forms and calcifies, but separate, common differences in drug‑processing genes can shape your response to medications used in Aortic valve disease 2. For example, variants in VKORC1 and CYP2C9 can lower the warfarin dose you need and increase bleeding risk, while changes in CYP2C19 can make clopidogrel less effective if you have a coronary stent or are prescribed it as part of your care. SLCO1B1 differences raise the chance of statin‑related muscle symptoms, and CYP2D6 can affect how you respond to codeine or tramadol for pain after surgery. Alongside medical history and the details of your valve condition, genetic testing may help guide dosing for some medicines. Genetic results are one piece of the picture, helping your team reduce trial‑and‑error and choose safer, effective options tailored to you.
Interactions with other conditions
Many people with aortic valve disease also live with high blood pressure or coronary artery disease, which adds extra strain on the heart and can blur what’s driving chest discomfort or breathlessness. Day-to-day, it can feel like one health issue amplifies the other. Irregular heart rhythms such as atrial fibrillation and conditions like heart failure often appear alongside aortic valve disease; skipped or fast beats can reduce the heart’s filling and trigger dizziness, while fluid buildup makes fatigue and ankle swelling worse. Chronic kidney disease, diabetes, and high cholesterol are linked to faster valve calcification, so aortic stenosis may progress more quickly when these are present. People with aortic valve disease also have a higher risk of infective endocarditis (a heart valve infection), making good dental care and prompt treatment of infections important. Some inherit a bicuspid aortic valve or a connective tissue condition, which can come with enlargement of the aorta and a higher chance of an aneurysm that needs regular checks. Sleep apnea, chronic lung disease, and anemia can further heighten shortness of breath and may delay recognizing early symptoms of aortic valve disease.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Throughout history, people have described sudden breathlessness and fainting during exertion, the kinds of episodes that, in hindsight, often pointed to trouble at the heart’s outlet valve. Family stories sometimes mentioned a harsh chest murmur heard by doctors placing an ear to the chest, long before modern scans existed. These lived experiences set the stage for what we now group as aortic valve disease 2.
First described in the medical literature as a stiff or narrowed aortic valve causing strain on the heart, these conditions were initially tracked through symptoms and bedside examination. As stethoscopes, then chest X‑rays, became common in the 19th and early 20th centuries, clinicians connected a telltale heart sound with reduced blood flow from the heart. Later, echocardiography in the 1970s and 1980s transformed care by letting teams watch valve motion in real time, making earlier recognition and monitoring possible.
From early theories to modern research, the story of aortic valve disease 2 also includes genetics. In some families, several relatives developed valve narrowing or needed surgery at relatively young ages. In recent decades, advances in genetics showed that changes in certain genes can act like a dimmer switch for how the valve forms and ages, helping explain why some people develop problems sooner or more severely than others. This genetic angle complemented long‑standing knowledge about age‑related wear, rheumatic fever in earlier generations, and calcium build‑up on the valve.
Surgery evolved alongside diagnosis. The first successful open‑heart valve replacements in the 1960s gave people with severe aortic valve disease 2 a new path forward. Tissue and mechanical valves improved over time, balancing durability with the need for blood thinners. More recently, less invasive catheter‑based valve replacement opened options for people who might not tolerate open surgery, widening access and shortening recovery.
Over time, the way the condition has been understood has changed, moving from bedside clues to precise imaging and genetic insight. Today’s approach blends careful listening to symptoms with ultrasound, CT when needed, and family history. This timeline matters for people living with aortic valve disease 2: it explains why doctors may ask about relatives, follow mild changes closely, and discuss a range of treatments that didn’t exist a few decades ago. Knowing the condition’s history helps make sense of the many paths to diagnosis and care in use today.