Aortic Stenosis

Overview

Aortic stenosis is a narrowing of the aortic valve, the one-way valve between the heart's main pumping chamber (the left ventricle) and the aorta, the large artery that carries blood to the rest of the body. When this valve does not open fully, the heart must work harder to push blood through the narrowed opening.

Over time, the strain can cause the heart muscle to thicken and weaken, leading to symptoms and eventually heart failure if untreated. Aortic stenosis often develops slowly over many years and may cause no symptoms at first. Once symptoms appear, it tends to progress, and valve replacement is usually needed. It is one of the most common valve problems, especially in older adults.

A key feature of aortic stenosis is that it can stay silent for years while it slowly worsens. The heart compensates by working harder, so people often feel well until the narrowing becomes severe. Once symptoms such as breathlessness, chest pain, or fainting appear, the condition usually needs prompt attention, because the outlook improves greatly with timely valve replacement.

Symptoms

Mild or moderate aortic stenosis often causes no symptoms. As the narrowing becomes severe, symptoms usually develop with exertion at first:

• Shortness of breath, especially with activity or when lying down
• Chest pain or tightness brought on by exertion
• Fainting or near-fainting (dizziness), particularly during exercise
• Fatigue and reduced ability to exercise
• A pounding, fluttering, or irregular heartbeat
• A heart murmur that a doctor may hear through a stethoscope

The combination of chest pain, fainting, and breathlessness in severe aortic stenosis is important, because these symptoms signal a higher risk and usually mean treatment is needed soon.

Causes

Aortic stenosis develops when the valve becomes stiff and narrowed. The main causes are:

• Age-related calcium buildup: The most common cause in older adults, in which calcium deposits gradually stiffen the valve over years.
• Bicuspid aortic valve: A valve present from birth with two flaps instead of three, which is more likely to narrow earlier in life.
• Rheumatic heart disease: Scarring of the valve after rheumatic fever, now less common in many countries.

Risk Factors

• Older age
• A bicuspid or otherwise abnormal aortic valve from birth
• A history of rheumatic fever
• High blood pressure and high cholesterol
• Chronic kidney disease
• Previous radiation therapy to the chest

Diagnosis

Aortic stenosis is often first suspected when a doctor hears a heart murmur. Tests confirm the diagnosis and grade its severity:

• Echocardiogram: An ultrasound of the heart that is the main test, showing how narrowed the valve is and how well the heart is pumping.
• Electrocardiogram (ECG): To check the heart's rhythm and look for strain on the heart.
• Chest X-ray: To assess heart size and the lungs.
• Cardiac catheterization or CT: Used in some cases, especially when planning treatment.

Treatment

There is no medication that reverses aortic stenosis. Treatment depends on the severity and whether symptoms are present.

• Monitoring: Mild or symptom-free disease is followed with regular echocardiograms.
• Managing related conditions: Controlling blood pressure, cholesterol, and other heart risks.
• Aortic valve replacement: The main treatment for severe, symptomatic disease. This can be done by open-heart surgery (SAVR) or by a less invasive catheter-based procedure (TAVR or TAVI) in suitable patients.
• Balloon valvuloplasty: Occasionally used, mainly as a temporary measure or in selected cases.

Once severe aortic stenosis causes symptoms, timely valve replacement greatly improves outlook, and the decision between surgery and a catheter-based approach is made by a heart team based on age, overall health, and risk.

Prevention and Self-Care

• Manage high blood pressure, high cholesterol, and diabetes to support overall heart health
• Do not smoke and stay physically active within limits advised by your doctor
• Attend all follow-up appointments and echocardiograms so the valve can be monitored
• Tell your dental and medical team about your valve condition before procedures
• Report new chest pain, breathlessness, or fainting promptly

When to See a Doctor

See a doctor if you have a known heart murmur or valve problem and develop breathlessness, chest pain, dizziness, fainting, or reduced ability to exercise. These symptoms can indicate that aortic stenosis has become severe.

Call emergency services for sudden severe chest pain, fainting, severe difficulty breathing, or a collapse. In severe aortic stenosis these can be signs of a dangerous drop in blood flow that needs immediate care.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Aortic valve stenosis.
2. American Heart Association. Problem: Aortic Valve Stenosis.
3. National Heart, Lung, and Blood Institute (NHLBI). Heart valve diseases.
4. MedlinePlus, U.S. National Library of Medicine. Aortic stenosis.