Aortic Stenosis

What is aortic stenosis?

Aortic valve stenosis (or aortic stenosis) describes an aortic valve in your heart that’s narrowed or blocked. This interferes with the normal blood flow out of your heart. Because this condition restricts blood flow, it also limits how much oxygen your body gets. This can cause chest pain, shortness of breath and fainting. Aortic stenosis can cause heart damage, major health problems and even death.

One of four valves in your heart, your aortic valve is the last one that blood flows through before going out to your body. Your aortic valve has three flaps (leaflets) that open to let blood pass through and then seal shut to keep blood from flowing backward into the last heart chamber.

A problem with this valve can be concerning. But today, there are more options than ever to treat aortic stenosis.

How common is aortic stenosis?

Aortic stenosis is common in people over 65. But many people don’t know they have it until it causes symptoms or shows up on a screening or diagnostic test.

Several diseases can also cause it to develop when people reach middle age. In rare instances, children can have a congenital (present at birth) condition that causes aortic valve stenosis.

What are the symptoms?

Aortic stenosis symptoms (progressing from less severe to more severe) include:

• Fatigue, which can disrupt your normal activities.
• Heart palpitations (being unpleasantly aware of your own heartbeat).
• Swelling in your feet, ankles or lower legs.
• Chest pain (angina). This can also feel like squeezing, pressure or discomfort and can extend to your neck, jaw, arm or abdomen.
• Shortness of breath.
• Dizziness, lightheadedness or fainting.

Your primary care provider may refer you to a cardiologist (heart doctor) if they suspect you have aortic stenosis.

How fast does the condition progress?

For some people, aortic valve stenosis can happen slowly and take several years. For others, it can happen much faster. If you wait too long for treatment, you may have heart damage that a provider can’t repair or reverse. In cases of severe aortic stenosis, there’s also a risk of dying suddenly. Because of this, your healthcare provider may advise you not to delay treatment.

What causes aortic stenosis?

Aortic stenosis in adults has three main causes:

• Wear and tear due to age: Over time, calcium can build up on your valve, limiting blood flow. This type of stenosis happens most commonly after age 65.
• Damage from infections: When bacteria from untreated infections reach your bloodstream, they can accumulate on your heart valves. This causes your immune system to damage the valve itself. This is most likely to happen with strep throat or scarlet fever, which, when untreated, can cause rheumatic fever. This disease, which can damage your heart valves, happens most often in those over 50. It may take years or decades before the damage to your heart valves becomes apparent.
• Other inherited or chronic conditions: Other rare conditions that can cause aortic valve stenosis are Paget’s disease of the bone, kidney failure and familial hypercholesterolemia. Aortic stenosis is also linked to autoimmune or inflammatory diseases like lupus and rheumatoid arthritis.

What are the risk factors for aortic stenosis?

Risk factors for aortic valve stenosis include:

• Being male.
• Being older than age 65.
• Having high cholesterol (hyperlipidemia).
• Having high blood pressure.
• Using tobacco products.

What are the complications of aortic stenosis?

When you have aortic stenosis, it takes more effort to move blood through your aortic valve. Your heart works harder than it should to push the blood through. This can lead to a heart attack, heart failure or sudden cardiac death.

People with aortic valve stenosis may also get pulmonary hypertension, bleeding or infective endocarditis.

How is aortic stenosis diagnosed?

A cardiologist will typically diagnose this condition based on your symptoms (if you have them) and one or more of the following diagnostic tests:

• Physical exam. Your provider may look for swelling in your lower legs and ankles, and will also listen to your heart. Providers can often hear a heart murmur, a key sign of aortic stenosis, using a stethoscope.
• Electrocardiogram (ECG or EKG). This measures your heart’s electrical activity.
• Chest X-ray, angiography or cardiac CT scan. Each of these uses X-rays to see inside your body.
• Echocardiogram. This test uses ultrasound waves to create a picture of the inside of your heart.
• Exercise stress testing. This test measures your heart function while you’re active.
• Cardiac catheterization. A provider uses a catheter threaded through your arteries to see inside your heart.
• Heart MRI (magnetic resonance imaging): Using a powerful magnetic field, this provides detailed scans of your heart.

Based on your symptoms and how well your aortic valve works, your provider may describe your case with a letter and, possibly, a number after it. Stages run from A through D, with D being the worst. Numbers 1 through 3 further describe cases, with 3 being the worst.

How is aortic stenosis treated?

If you have stenosis but no symptoms, your healthcare provider may advise you to simply monitor the issue with follow-up visits and tests. If you develop symptoms, your provider can offer you aortic stenosis treatment options, including:

• Medication: Providers treat milder cases of aortic valve stenosis with medications. These may include blood thinners, diuretics and other medicines to treat heart rhythm disorders, high blood pressure or heart failure. Medications help with symptoms but can’t keep stenosis from getting worse.
• Valve repair: This involves either surgery or balloon valvuloplasty. During aortic valve surgery, a surgeon makes an incision in your chest to directly reach and repair the valve. If you have limited damage and little blood leakage, a provider may use balloon valvuloplasty. This widens your narrowed aortic valve and may improve symptoms until you can have a valve replacement.
• Valve replacement: Valve replacement offers several options for people who can’t have a valve repair. Aortic valve surgery replaces the valve with a donor valve (usually from a cow or pig), a mechanical valve or a bioprosthetic valve. Another option is a Ross procedure, which uses your own pulmonary valve to replace your damaged aortic valve. A provider then uses a donor valve to replace your pulmonary valve. Finally, a transcatheter aortic valve replacement (TAVR) allows for the replacement of an aortic valve without surgery. This procedure involves inserting a catheter-based device into an artery and then threading it to your heart.

How long does it take to recover from this treatment?

Recovery from aortic valve stenosis repair or replacement depends on the method a provider uses. Surgical methods take the longest. People who have surgery are typically in the hospital for several days, with full recovery usually taking several weeks.

Transcatheter methods like balloon valvuloplasty and TAVR have shorter recovery times. In some cases, people who have these types of procedures can go home either the same or the next day and resume their everyday lives shortly after.

Can aortic stenosis be prevented?

Treating bacterial infections promptly is the only way to prevent aortic stenosis. This includes taking antibiotics and other medications as directed, not just until you feel better.

You usually can’t prevent aortic valve stenosis that results from aging or from inherited or chronic conditions.

What can I expect if I have aortic stenosis?

Your outlook with aortic stenosis depends on how quickly you get treatment.

• Untreated: Untreated aortic stenosis can cause big disruptions in your life, especially once it becomes severe or critical. Most people don’t survive more than a few years without treatment.
• Delayed treatment: Waiting to treat aortic stenosis usually has a mixed prognosis (outlook), depending on whether there’s permanent heart damage. The greater the damage, the worse the outlook. You may recover to a certain point, but a full recovery is unlikely.
• Timely or early treatment: With timely or early treatment, the prognosis for aortic stenosis is good or excellent. You’ll need lifelong follow-up care, but otherwise can resume most or all of your usual activities.

How do I take care of myself?

If you have mild aortic stenosis or no symptoms, you may only need routine echocardiograms and regular follow-up appointments.

If you have moderate aortic valve stenosis, you may need to monitor symptoms, get routine echocardiograms and limit your activity. You may also need to take medications to prevent clotting or treat other issues related to aortic stenosis. You may need to take medication either temporarily or permanently. Your healthcare provider can explain what medications you’ll need to take, how you should take them and for how long.

With severe aortic valve stenosis, you’ll likely need follow-up visits after a valve repair or replacement. You may also need to take certain medicines.

For all severity levels, your provider will likely recommend eating low-salt, low-fat foods and getting regular physical activity. They can tell you what level of activity is right for you.

When should I see my healthcare provider?

If you choose not to have treatment or haven’t received treatment yet, you should call your healthcare provider if the following happens:

• You develop a new symptom of aortic stenosis or any of your symptoms suddenly get worse.
• Your symptoms start to disrupt your life.

When should I go to the ER?

After starting a new medication, you should go to the emergency room if any of the following happens:

• You have an unexpected side effect from your medicine. Your healthcare provider can tell you which side effects need immediate medical attention.
• You faint or pass out for any reason.
• You’re taking blood thinners and fall. Blood thinners greatly increase the risk of internal bleeding — especially after a fall or another injury.

After a surgery or catheter procedure, you should go to the ER if any of the following happens:

• Your incision site becomes red, swollen or hot to the touch. These are signs of an infection that needs immediate treatment.
• You have any serious aortic stenosis symptoms — including shortness of breath, chest pain or heart palpitations — or if you faint.
• You’re on blood thinners and fall, for the same reason listed above.

What questions should I ask my healthcare provider?

Questions to consider asking your provider include:

• Do you think my symptoms will get worse?
• Will I need a valve replacement?
• What type of replacement valve should I get?
• When is the best time for me to have surgery?