Aortic valve stenosis, or simply, aortic stenosis, is the most prevalent and concerning valvular heart disease. Aortic stenosis is a condition in which the aortic valve, the valve responsible for controlling blood- flow from the heart to the rest of the body, becomes narrowed, limiting the amount of blood that can flow through it. Numerous conditions, including rheumatic fever scarring, calcium accumulation, and congenital anomalies, can result in this constriction. If neglected, the illness can result in significant problems including heart failure or sudden cardiac arrest. It can also produce symptoms like chest discomfort, shortness of breath, and fainting.
Understanding aortic stenosis and your choices for treatment is crucial if you or a loved one has been given the diagnosis. The causes, signs, prognosis, and treatment of aortic stenosis are covered in the sections that follow, along with some frequently asked questions and issues related to this disease.
The heart has four chambers, and four channels that allow the inflow and outflow of the blood through these chambers. The most important chamber is the left ventricle, which receives oxygenated blood from the lungs, via the left atrium, and pumps it to the entire body through the aorta, the body's largest artery. The opening between the channels and the chambers is controlled through special flap-like structures called valves. The aortic valve is one of the four valves in the heart and is responsible for controlling blood flow from the left ventricle to the aorta
Aortic stenosis occurs when the aortic valve becomes narrowed, which can impede blood flow from the heart and lead to complications. The most common cause of aortic stenosis is degenerative changes in the valve that occur with ageing. In some cases, aortic stenosis may not cause any noticeable symptoms, but as the condition progresses, it can lead to chest pain, shortness of breath, fatigue, and fainting. 1,2
Causes of aortic valve stenosis
Aortic stenosis can have several underlying causes, including congenital abnormalities and acquired diseases.
Congenital: Congenital aortic stenosis can occur when the aortic valve has only two leaflets instead of the normal three, a condition known as a bicuspid valve. This is the most common cause of Aortic Stenosis in young patients.
Ageing: Aortic stenosis can develop with age as a result of calcium buildup on the valve leaflets, which can cause them to become stiff and narrow.
Acquired: Rheumatic Fever, a complication of untreated strep throat, can result in the scarring and eventual narrowing of heart valves. Other acquired causes include tri-leaflet valve, alkaptonuria, systemic lupus erythematosus, ochronosis, irradiation, and end-stage renal disease.3
Signs and symptoms of aortic valve stenosis
The condition is relatively asymptomatic in the early stages. The symptoms and signs become evident as the condition progresses. The signs and symptoms of aortic stenosis include:
- Chest Pain
- Shortness of Breath
In severe cases, aortic stenosis can lead to heart failure, sudden cardiac arrest, or even death. 4
Management and treatment for aortic valve stenosis
The treatment and management of aortic stenosis depend on the severity of the condition and the presence of symptoms. Treatment options can range from medications to surgical intervention.
Medications: Medications may be prescribed to manage symptoms of aortic stenosis, such as high blood pressure or heart failure. These may include diuretics, ACE inhibitors, beta-blockers, and calcium channel blockers. However, medications cannot stop the progression of the disease or reverse the narrowing of the aortic valve.
Valve Replacement: In more severe cases of aortic stenosis, surgical intervention may be necessary. There are two main types of valve replacement surgery:
Open-Heart Surgery: This is the most common type of surgery for aortic valve replacement. During this procedure, the damaged aortic valve is removed and replaced with a mechanical or biological valve.
Transcatheter Aortic Valve Replacement (TAVR): This is a minimally invasive procedure that involves threading a catheter through a blood vessel to the heart. A new valve is then implanted over the old, damaged valve.2
Balloon Valvuloplasty: This is a less invasive procedure that involves using a catheter with a balloon at the tip to widen the valve opening. While this procedure may be effective in some cases, it is typically not a long-term solution and the valve may need to be replaced in the future.3
Diagnosis of aortic valve stenosis
Aortic stenosis is typically diagnosed using a combination of medical history, physical examination, and diagnostic testing. Patients gradually have a decreased capacity for activity, as well as weariness and dyspnea when they push themselves. The physical cardiovascular examination includes auscultation which identifies the audible systolic murmurs.
Doctors may use imaging tests such as echocardiography or cardiac catheterization to assess the severity of the condition and determine the most appropriate treatment plan. Transthoracic echocardiography is the gold standard for diagnosing suspicious cases. Other tests such as ECG, cardiac MRI, chest X-ray, and stress tests can be employed too.4,5
The following factors are associated with aortic stenosis:
- Family History
- Abnormal or deformed aortic valve
- High cholesterol
- History of Streptococcal throat infection or Rheumatic Fever
- Chronic Kidney Disease 2
If left untreated, aortic stenosis can lead to serious complications, including heart failure, sudden cardiac arrest, and death. As the condition progresses, the heart may become weaker and less able to pump blood effectively. This can cause fluid to build up in the lungs (pulmonary oedema), leading to shortness of breath and difficulty breathing. In some cases, blood may back up into the veins, causing swelling in the legs and ankles. In severe cases, aortic stenosis can lead to sudden cardiac arrest. It also increases the risk of Infective endocarditis, embolic stroke, and GI bleeding.3
How common is aortic valve stenosis?
Aortic stenosis grows more common as people age, with an incidence of 9 to 45% in individuals with a mean age of 54 to 81. Geographically, calcific stenosis is more prevalent in North America and Europe, whereas rheumatic valve disease is more prevalent in underdeveloped nations. The population's ageing is predicted to cause this prevalence to double or triple in the ensuing decades.3
How can I prevent aortic valve stenosis?
Maintaining a healthy diet and lifestyle, managing high blood pressure, and treating infections such as strep throat promptly to reduce the risk of rheumatic fever. If you have a family history of heart disease or aortic stenosis, talk to your doctor about monitoring your heart health and taking steps to reduce your risk.
When should I see a doctor?
If you are experiencing symptoms such as chest pain, shortness of breath, or fainting, it is important to see a doctor right away. These symptoms may indicate a serious underlying heart condition such as aortic stenosis. Additionally, if you are at increased risk of developing aortic stenosis due to factors such as age, family history, or high blood pressure, you should talk to your doctor about monitoring your heart health and taking steps to reduce your risk.
Aortic stenosis is a condition in which the aortic valve becomes narrowed, limiting blood flow from the heart to the rest of the body. The condition can be caused by congenital abnormalities, calcium buildup, or scarring from rheumatic fever. Symptoms may include chest pain, shortness of breath, and fainting, and if left untreated, the condition can lead to serious complications such as heart failure or sudden cardiac arrest. Treatment for aortic stenosis depends on the severity of the condition and may include medication or surgery. Maintaining a healthy diet and lifestyle, managing high blood pressure, and treating infections promptly can reduce the risk of developing the condition. If you are experiencing symptoms or are at increased risk of developing aortic stenosis, it is important to talk to your doctor about monitoring your heart health and taking steps to reduce your risk.
- Aortic stenosis overview [Internet]. www.heart.org. [cited 2023 Apr 26]. Available from: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis
- What is aortic stenosis [Internet]. The Heart & Vascular Centre. 2018 [cited 2023 Apr 26]. Available from:
- Pujari SH, Agasthi P. Aortic Stenosis. StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557628/
- Hurrell H, Redwood M, Patterson T, Allen C. Aortic stenosis. BMJ [Internet]. 2023 [cited 2023 Apr 26];380:e070511. Available from: https://www.bmj.com/content/380/bmj-2022-070511
- Aortic Stenosis symptoms, risk factors, diagnosis and treatment [Internet]. Narayana Health. 2021 [cited 2023 Apr 26]. Available from: https://www.narayanahealth.org/procedures/aortic-stenosis