Aortic Valve Stenosis
A narrowed aortic valve that restricts blood flow from the heart
Quick Facts
- Type: Heart valve disease
- Valve affected: Aortic valve
- Common cause: Age-related calcium buildup
- Warning symptoms: Chest pain, breathlessness, fainting
Overview
Aortic valve stenosis is a narrowing of the aortic valve, the valve through which blood leaves the heart to travel to the rest of the body. When this valve becomes stiff and narrowed, the heart must work much harder to push blood through the smaller opening. Over time, this extra strain causes the heart muscle to thicken and can lead to symptoms and heart problems.
Aortic stenosis is one of the most common valve conditions, especially in older adults, where it usually results from calcium building up on the valve with age. Once symptoms such as chest pain, breathlessness, or fainting appear, the condition is considered serious and often needs valve replacement. With timely treatment, outcomes are generally good.
Symptoms
Aortic stenosis often develops slowly, and many people have no symptoms until the narrowing becomes significant. Key symptoms include:
- Chest pain or tightness, especially with activity
- Shortness of breath, particularly with exertion
- Fainting or lightheadedness, especially during activity
- Fatigue and reduced ability to exercise
- Heart palpitations
- A heart murmur heard by a clinician
The combination of chest pain, fainting, and breathlessness signals advanced disease. Seek emergency care for fainting, severe chest pain, or sudden severe shortness of breath.
Causes
Aortic stenosis occurs when the valve leaflets thicken, stiffen, or fuse, narrowing the opening. Causes include:
- Age-related calcium buildup: The most common cause in older adults, as calcium deposits stiffen the valve over decades.
- Bicuspid aortic valve: A valve that has two leaflets instead of three from birth, which tends to narrow earlier in life.
- Rheumatic fever: Valve scarring from a past infection.
- Other rare causes: Including certain inherited and metabolic conditions.
Risk Factors
- Older age
- A bicuspid (two-leaflet) aortic valve
- A history of rheumatic fever
- High blood pressure and high cholesterol
- Chronic kidney disease
- Previous radiation to the chest
Diagnosis
Aortic stenosis is often first suspected from a heart murmur. Tests confirm the diagnosis and measure how severe the narrowing is.
- Echocardiogram: The main test, an ultrasound that shows the valve, measures the narrowing, and assesses heart function.
- Electrocardiogram (ECG): Checks the heart's electrical activity and any strain.
- Chest X-ray: May show heart enlargement or valve calcium.
- Cardiac catheterization or CT: Used in some cases to assess severity and plan treatment.
Treatment
The definitive treatment for significant aortic stenosis is replacing the valve, since medications cannot reopen it. The approach depends on severity, symptoms, and overall health.
- Monitoring: Regular echocardiograms for mild or symptom-free disease.
- Medications: To manage blood pressure, symptoms, and related heart conditions, though they do not fix the valve.
- Surgical aortic valve replacement: Open-heart surgery to replace the valve.
- Transcatheter aortic valve replacement (TAVR): A less invasive procedure that places a new valve through a catheter, often used for higher-risk or older patients.
Once symptoms develop, prompt evaluation for valve replacement is important.
Prevention
- Manage cardiovascular risk factors such as high blood pressure and high cholesterol
- Do not smoke
- Treat strep throat promptly to help prevent rheumatic fever
- Maintain good dental and skin hygiene to reduce the risk of valve infection
- Attend regular check-ups, especially if you have a known murmur or bicuspid valve
When to See a Doctor
See a clinician if you have been told you have a heart murmur, or if you notice chest pain, breathlessness, or lightheadedness with activity. These can be early signs that the valve is narrowing. Seek emergency care for fainting, severe or persistent chest pain, or sudden severe shortness of breath, which require immediate attention.
Frequently Asked Questions
What causes aortic valve stenosis?
In older adults, the most common cause is calcium building up on the valve over decades, which stiffens and narrows it. Other causes include being born with a two-leaflet (bicuspid) valve, which narrows earlier in life, and valve scarring from past rheumatic fever.
What are the warning symptoms of aortic stenosis?
The classic warning symptoms are chest pain, fainting or lightheadedness, and shortness of breath, especially with activity. Once these appear, the condition is considered serious and should be evaluated promptly for valve replacement.
How is aortic valve stenosis treated?
Significant aortic stenosis is treated by replacing the valve, either with open-heart surgery or a less invasive catheter procedure called TAVR. Medications can help manage symptoms and related conditions but cannot reopen the narrowed valve.
Is aortic stenosis dangerous?
It can be. Mild stenosis without symptoms is often just monitored, but severe stenosis that causes chest pain, fainting, or breathlessness is serious and can lead to heart failure or sudden problems if untreated. Fainting and severe chest pain are emergencies.
Can aortic stenosis be treated with medication alone?
No. Medications can control blood pressure, symptoms, and related heart conditions, but they cannot widen the narrowed valve. The only definitive treatment for significant aortic stenosis is valve replacement.
References
- American Heart Association. Problem: Aortic Valve Stenosis.
- MedlinePlus, U.S. National Library of Medicine. Aortic stenosis.
- Mayo Clinic. Aortic valve stenosis — Symptoms and causes.
- National Heart, Lung, and Blood Institute (NHLBI). Heart Valve Diseases.