Does moderate aortic (mod) stenosis cause dizziness?

Moderate Aortic Stenosis and Dizziness

Yes, moderate aortic stenosis can cause dizziness, which is recognized as one of the characteristic symptoms of aortic stenosis, even at the moderate stage. 1

Pathophysiology and Symptom Correlation

Moderate aortic stenosis creates increased afterload on the left ventricle, leading to:

• Reduced cardiac output, especially during exertion
• Impaired cerebral perfusion during position changes or exertion
• Potential for transient hypotension with activity

The European Society of Cardiology guidelines specifically identify dizziness as one of the key symptoms that should be carefully assessed in patients with aortic stenosis 1. This symptom often precedes more severe manifestations like syncope, which is more commonly associated with severe aortic stenosis.

Clinical Presentation

Dizziness in moderate aortic stenosis typically presents as:

• Exertional light-headedness
• Positional dizziness (especially when standing quickly)
• Sensation of unsteadiness with activity
• Intermittent episodes that resolve with rest

It's important to note that patients may subconsciously reduce their activities to avoid symptoms, making careful questioning about subtle symptoms critical 1. Some patients may deny symptoms as they gradually adapt their lifestyle to accommodate their limitations.

Diagnostic Considerations

When evaluating dizziness in a patient with moderate aortic stenosis:

1. Exercise stress testing may be valuable to unmask symptoms not apparent at rest
2. Careful auscultation for the characteristic systolic murmur that radiates to the carotids
3. Echocardiography to confirm moderate stenosis (typically defined as mean gradient 25-40 mmHg or peak instantaneous gradient 40-70 mmHg) 1

Management Implications

The presence of dizziness in a patient with moderate aortic stenosis has important management implications:

• Symptoms like dizziness should prompt more frequent monitoring (every 6 months rather than annually) 2
• Symptomatic patients with moderate aortic stenosis should be referred to cardiology 3
• Exercise limitations may be appropriate, particularly avoiding competitive sports that could cause blood pressure spikes 1
• Careful medication management, particularly with antihypertensives, which should be initiated at low doses and gradually titrated 2

Risk Stratification

Patients with moderate aortic stenosis who experience dizziness may have a higher risk profile. Research has shown that moderate aortic stenosis has worse outcomes than commonly assumed, with significant progression and excess mortality 4. Factors associated with poorer outcomes include:

• Valve calcification
• Coronary artery disease
• Rapid progression of aortic jet velocity 4

Follow-up Recommendations

For patients with moderate aortic stenosis experiencing dizziness:

• More frequent clinical evaluation (every 6 months)
• Regular echocardiographic assessment (every 12 months) 2
• Prompt reporting of worsening symptoms or new symptoms like syncope, angina, or heart failure
• Consideration of earlier intervention if symptoms progress or stenosis severity increases

Conclusion

Dizziness is a recognized symptom of moderate aortic stenosis that should not be dismissed. It represents an important clinical indicator that may signal disease progression and should prompt appropriate evaluation and monitoring to optimize patient outcomes related to morbidity and mortality.