Understanding Aortic Stenosis: A Patient Guide
What Is Aortic Stenosis?
Aortic stenosis is a narrowing of your aortic valve—the main valve that controls blood flow from your heart's pumping chamber to the rest of your body. 1 When this valve becomes narrowed, your heart must work much harder to pump blood through the smaller opening, which can eventually lead to serious problems if left untreated. 2
What Causes This Condition?
The most common cause in adults is calcification—a buildup of calcium deposits on the valve leaflets that makes them stiff and unable to open fully. 1 This is essentially a wear-and-tear process that becomes more common as we age, affecting about 3% of people over 65 years old. 3
Other causes include:
- Bicuspid aortic valve: A congenital condition where you're born with only two valve leaflets instead of the normal three, which tends to wear out earlier in life 1
- Rheumatic heart disease: Damage from childhood rheumatic fever, though this is now rare in developed countries 1
How Does It Affect Your Heart?
As the valve narrows, two important things happen:
- Your heart muscle thickens (left ventricular hypertrophy) to generate more force to push blood through the narrowed valve 2
- Your heart's pumping chamber becomes stiffer, making it harder for your heart to fill with blood between beats 2
Initially, these changes help your heart compensate, but over time they can lead to heart failure if the valve isn't replaced. 3
What Symptoms Should You Watch For?
Many people have no symptoms for years while the stenosis is mild or moderate. 3 However, once symptoms develop, they are serious warning signs that require prompt attention:
- Chest pain or pressure (angina), especially with exertion 4
- Shortness of breath, particularly during activity or when lying flat 4
- Dizziness or fainting (syncope), especially with exertion 4
- Fatigue and reduced ability to exercise 3
If you develop any of these symptoms, you must report them to your doctor immediately, as survival without treatment averages only 2-3 years once symptoms appear. 3
How Is It Diagnosed?
Your doctor will use echocardiography (ultrasound of the heart) as the primary test to diagnose and measure the severity of your aortic stenosis. 1 This test measures:
- How fast blood flows through the valve (velocity ≥4.0 m/s indicates severe stenosis) 5
- The pressure difference across the valve (mean gradient ≥40 mmHg indicates severe stenosis) 5
- The valve opening area (area <1.0 cm² indicates severe stenosis) 5
Additional tests may include CT scans to measure calcium buildup on the valve, with sex-specific thresholds (≥2000 units in men, ≥1200 units in women suggesting severe disease). 6
What About Treatment?
There is currently no medication that can reverse or stop the progression of aortic stenosis. 2 The definitive treatment is valve replacement, either through:
- Surgical valve replacement (open-heart surgery) 7
- Transcatheter aortic valve replacement (TAVR): A less invasive procedure where a new valve is inserted through a catheter 1
The timing of valve replacement is critical. If you have severe stenosis with symptoms, valve replacement is strongly recommended and can restore a normal lifespan. 3, 8 For asymptomatic patients, careful monitoring with regular echocardiograms is essential—annually for severe disease, every 1-2 years for moderate disease, and every 3-5 years for mild disease. 3
Important Lifestyle Considerations
- Avoid strenuous or competitive sports if you have moderate-to-severe stenosis 1
- Report any new symptoms immediately to your doctor, as this changes management 3
- Maintain regular follow-up appointments and echocardiograms as recommended 1
- Manage other heart conditions carefully, including high blood pressure, atrial fibrillation, and coronary artery disease 3
The Bottom Line
Aortic stenosis is a progressive condition that requires careful monitoring. While it may not cause symptoms initially, once symptoms develop, valve replacement becomes necessary and life-saving. Your most important role is to attend regular follow-up appointments and immediately report any new symptoms of chest pain, shortness of breath, or dizziness to your healthcare team. 3