About- Aortic stenosis, also called aortic valve stenosis, is a condition in which the aortic valve becomes narrowed or stiffened. The aortic valve is one of the four valves in the heart. It lies between the left ventricle and the aorta, the body’s main artery. Normally, the aortic valve opens widely when the heart pumps, allowing oxygen-rich blood to flow from the left ventricle into the aorta and then to the rest of the body. In aortic stenosis, the valve does not open completely. This makes it harder for blood to leave the heart. As the narrowing becomes more severe, the heart has to work harder to pump blood through the valve. Over time, this extra workload can cause the heart muscle to thicken and may eventually lead to heart failure and other serious complications. Aortic stenosis can range from mild to severe. Some people have no symptoms for many years, while severe symptomatic aortic stenosis requires prompt medical evaluation and may require aortic valve replacement.
Swelling of the ankles, feet or legs, particularly in advanced disease
Difficulty breathing when lying down in advanced cases
Symptoms may initially appear only during exercise or other physical activity. As aortic stenosis progresses, symptoms may occur with less activity or even at rest.
A person can have significant aortic stenosis without obvious symptoms, especially in the early stages. This is one reason why regular medical examinations can be important. A doctor may detect a characteristic heart murmur during a routine examination and recommend further testing.
In older adults, the most common cause is age-related calcium buildup and degeneration of the aortic valve. Over many years, calcium and other deposits can accumulate on the valve. The valve may become thick, stiff and less able to open properly.
Some people are born with an aortic valve that has two leaflets instead of the normal three. This is called a bicuspid aortic valve. A bicuspid valve can become narrowed earlier in life than a normal three-leaflet valve and can also be associated with other problems involving the aorta.
Rheumatic fever can damage heart valves. Repeated or severe rheumatic valve damage may cause the aortic valve leaflets to become thickened, scarred or fused, resulting in narrowing.
Some people are born with abnormalities of the aortic valve or other parts of the heart. These congenital heart defects can increase the risk of developing aortic stenosis.
When the aortic valve becomes narrowed, the left ventricle must generate greater pressure to push blood through the smaller opening. At first, the heart may compensate by making the muscular wall of the left ventricle thicker. This is known as left ventricular hypertrophy. As the disease progresses, the heart may eventually become unable to pump effectively. This can result in:
Reduced blood flow to the body
Shortness of breath
Reduced exercise capacity
Heart failure
Abnormal heart rhythms
Fainting
Increased risk of serious cardiovascular complications
A doctor may listen to the heart with a stethoscope. Aortic stenosis commonly produces a characteristic heart murmur, particularly when the valve is significantly narrowed. The doctor may also check for symptoms such as swelling, abnormal blood pressure, reduced pulse strength or signs of heart failure.
An echocardiogram (echo) is one of the most important tests for diagnosing and assessing aortic stenosis. It uses ultrasound waves to create images of the heart and can help determine:
The structure of the aortic valve
How well the valve opens
The speed of blood flow through the valve
The pressure difference across the valve
The size and function of the heart chambers
Whether the heart muscle has become thickened or weakened
The severity of aortic stenosis is generally assessed using echocardiographic measurements along with the overall clinical picture.
An electrocardiogram (ECG or EKG) records the electrical activity of the heart. It may show changes associated with thickening of the heart muscle or abnormal heart rhythms.
Doctors generally classify aortic stenosis as mild, moderate or severe, based on measurements from echocardiography and other clinical findings.
The severity is not determined by a single measurement alone. Doctors consider factors such as:
Valve opening area
Blood flow velocity through the valve
Pressure gradient across the valve
Heart function
Symptoms
Other medical conditions
A person with severe aortic stenosis may initially have few or no symptoms, so regular follow-up can be important.
There is currently no medicine that can open a severely narrowed aortic valve. However, medicines may be prescribed to treat associated conditions such as:
High blood pressure
Heart failure
Abnormal heart rhythms
High cholesterol
Other cardiovascular risk factors
Medication should be taken only as directed by a healthcare professional.
When aortic stenosis becomes severe and causes symptoms or affects heart function, aortic valve replacement may be recommended. The two main approaches are:
Transcatheter aortic valve replacement (TAVR), also called transcatheter aortic valve implantation (TAVI), is a less invasive procedure in which a replacement valve is delivered through a catheter, commonly through an artery in the groin, and positioned inside the diseased valve. TAVR may be appropriate for many people with severe aortic stenosis, depending on their age, anatomy, health status and other factors. The decision between TAVR and surgical valve replacement should be made by a specialized heart team.
Chest pain that is severe, persistent or accompanied by difficulty breathing, fainting, sweating, nausea or other concerning symptoms requires urgent medical attention. Sudden severe shortness of breath or loss of consciousness should also be treated as a medical emergency.
People with mild or moderate aortic stenosis can often continue many normal activities, depending on their individual condition. Helpful measures may include:
Attend scheduled cardiology appointments.
Have echocardiograms as recommended.
Report new symptoms promptly.
Control blood pressure, blood sugar and cholesterol.
Avoid smoking.
Follow a heart-healthy diet.
Maintain an appropriate level of physical activity as advised by a healthcare professional.
Take prescribed medicines correctly.
Inform healthcare professionals about the valve condition before procedures when appropriate.
People with significant aortic stenosis should discuss the appropriate level of physical activity with their doctor.
Not every case of aortic stenosis can be prevented, particularly valve disease related to aging or congenital abnormalities. However, maintaining good cardiovascular health may help reduce some risk factors and protect overall heart health. Helpful measures include:
Controlling high blood pressure
Managing cholesterol
Maintaining a healthy weight
Managing diabetes
Avoiding tobacco
Eating a balanced diet
Exercising appropriately
Treating infections such as streptococcal throat infections promptly, as advised by a healthcare professional
Following medical advice if there is a history of rheumatic fever or congenital valve disease
Age-related calcification of the aortic valve is an important cause of aortic stenosis in older adults. Because symptoms may develop gradually, people may mistakenly attribute increasing tiredness or reduced exercise ability to normal aging. However, new or worsening shortness of breath, chest pain, dizziness or fainting should not simply be considered a normal part of aging. A medical evaluation can determine whether a heart valve problem or another condition is responsible.
Aortic stenosis in children and younger adults is more likely to be associated with congenital abnormalities, particularly a bicuspid aortic valve. Children and young adults with congenital valve disease may require long-term monitoring by a cardiologist. The frequency of follow-up depends on the severity of the valve abnormality and other individual factors.
Common symptoms include chest pain, shortness of breath, dizziness, fainting, fatigue and reduced ability to exercise. A heart murmur may also be detected by a doctor.
Medicines can help manage associated cardiovascular conditions, but they cannot reverse severe narrowing of the aortic valve. When severe aortic stenosis requires treatment, the valve can generally be replaced surgically or through a transcatheter procedure.
Mild aortic stenosis may remain stable for years. Severe symptomatic aortic stenosis can be a serious and potentially life-threatening condition and requires evaluation by a cardiologist.
Yes. Severe narrowing of the aortic valve can limit the amount of blood that the heart can pump, particularly during exertion, and may cause dizziness or fainting.
No. People with mild or moderate disease and no significant symptoms may only require regular monitoring. Severe disease may require valve replacement depending on symptoms, heart function and other factors.
TAVR, or transcatheter aortic valve replacement, is a minimally invasive procedure used to replace a diseased aortic valve through a catheter rather than traditional open-heart surgery.
Many people with mild aortic stenosis can live normally with appropriate medical monitoring. Severe disease may require treatment, and outcomes can improve significantly when appropriate valve replacement is performed.
This information is intended for general educational purposes only and should not be considered a substitute for professional medical advice, diagnosis or treatment. Aortic stenosis can vary considerably from one person to another. Anyone with symptoms of possible heart disease should consult a qualified healthcare professional. In an emergency, seek immediate medical attention.
