What Is Aortic Stenosis?

Early intervention is key to relieving aortic stenosis symptoms

Your aortic valve plays a crucial role in keeping blood flowing from your heart’s lower left chamber to the aorta, the main artery that delivers blood from your heart to the body.

But if the aortic valve starts to narrow, most commonly due to aging and calcium buildup, it can lead to serious complications like stroke, heart failure or sudden cardiac arrest, if left untreated.

Known as aortic stenosis, it’s one of the most common progressive heart valve diseases that can block blood flow to the rest of the body. For some people, aortic stenosis progresses gradually without noticeable signs, but for others, it can advance quickly.

“Early diagnosis and treatment are key to relieving symptoms, improving daily function and extending life expectancy,” says Arav Jhand, MD, an interventional cardiologist at Geisinger. “Aortic stenosis is a complicated heart condition, but advances in minimally invasive techniques like TAVR have made the ability to treat it better than ever — with outcomes as good as conventional open heart surgery.”

What is aortic stenosis?

Aortic stenosis is a narrowing of the aortic valve opening that limits blood flow from the heart to the body. The aortic valve sits between the heart’s left ventricle and the aorta, the body’s main artery.

In a healthy heart, the valve opens widely with each heartbeat to let oxygen-rich blood flow forward and then closes to keep blood from leaking back.

But when the valve becomes stiff or narrowed, blood flow is reduced from the heart to the aorta and rest of the body. The heart must pump harder to push blood through the narrowed valve. This extra workload can thicken the heart muscle and weaken it, raising the risk of heart failure.

Aortic stenosis symptoms

Aortic stenosis can range from mild to severe, and symptoms vary based on the degree of narrowing. You might have mild aortic stenosis and not have symptoms for many years. But as the condition progresses and becomes severe, aortic stenosis symptoms can include:

Shortness of breath, reduced exercise tolerance or feeling winded with routine tasks
Chest pain or tightness, especially during activity
Fainting or lightheadedness, particularly with exertion
Fatigue, weakness or decreased stamina
Heart palpitations or irregular heartbeat
Heart murmur, or an abnormal swooshing sound

If you have symptoms, especially during activity, your primary care provider may refer you to a cardiologist. Even mild or moderate aortic stenosis symptoms warrant evaluation because once symptoms begin, aortic stenosis can progress quickly.

Seek emergency care if you have chest pain, sudden shortness of breath or fainting episodes.

Aortic stenosis risk factors

Anyone can develop aortic stenosis, but several risk factors increase your chances:

Age. Age-related wear and tear or aortic valve calcification — where calcium deposits build up and narrow the valve over time — are most common in adults over 65.
Family history. Valve disease and congenital heart defects can run in families, especially a bicuspid aortic valve — which has 2 cusps or flaps, instead of the usual 3. A bicuspid aortic valve can wear out faster and lead to earlier disease.
Prior rheumatic fever infection. This untreated complication of strep throat can damage heart valves and leave behind scar tissue, which narrows the aortic valve opening. The scar’s rough surface also can attract calcium deposits.
Cardiovascular risk factors. High blood pressure, high cholesterol, diabetes and smoking contribute to valve calcification and heart strain.
Chronic kidney disease. It can alter calcium and phosphate balance, accelerating valve calcification.
Prior chest radiation therapy. The treatment can scar and stiffen heart valves over time.

“The most common cause of aortic stenosis is age-related calcification,” says Dr. Jhand. “Knowing your aortic stenosis risk factors can help you and your care team monitor for changes and plan timely aortic stenosis treatment.”

Aortic stenosis treatment

After an evaluation and testing confirms a diagnosis, your provider will assign a stage to your disease.

“Aortic stenosis has 4 stages, A through D, with D being the most severe obstruction,” says Dr. Jhand. “Each stage depends on several factors, including symptoms, disease severity, structure of the valve and blood flow through the heart and lungs.”

Aortic stenosis treatment depends on symptoms and stage of your disease. For mild cases without symptoms, your provider may recommend careful monitoring with regular follow-up and testing, such as echocardiograms.

Your provider also may prescribe medications to ease symptoms and reduce risk of complications, such as diuretics for fluid buildup, blood thinners and others to reduce high blood pressure and cholesterol.

In addition, a heart-healthy lifestyle — from eating healthy and exercising regularly to controlling high blood pressure and blood sugar — may help slow progression.

“But medications and lifestyle habits do not reverse the narrowing of the aortic valve,” says Dr. Jhand. “When aortic stenosis progresses to moderate or severe and symptoms develop, valve replacement surgery is necessary to protect heart function and improve longevity.”

TAVR procedure for valve replacement

Transcatheter aortic valve replacement (TAVR) is increasingly becoming the gold standard in aortic stenosis treatment. It’s a minimally invasive option to open heart surgery.

During a TAVR procedure, a small catheter is inserted through an artery in the groin. Using imaging guidance, a catheter is advanced to the heart and a new valve is placed inside the existing narrowed one. The new valve is then expanded, either with a balloon or a self-expanding spring frame, to restore forward blood flow immediately.

“TAVR offers patients with severe aortic stenosis a less invasive option with excellent results,” says Dr. Jhand. “The catheter-based procedure, almost always done without general anesthesia, leads to shorter hospital stays, faster recoveries and fewer complications compared to open heart surgery.”

However, some patients, like those with bicuspid valves, may require open heart surgery, known as surgical aortic valve replacement (SAVR), to remove and replace the damaged valve.

When to talk to your doctor

Regular checkups are important, especially if you have aortic stenosis risk factors or a known heart murmur or congenital heart defect. But if you develop symptoms or they get worse, call your doctor to schedule an appointment.

“Early evaluation helps identify changes in valve function and makes sure you receive timely aortic stenosis treatment,” says Dr. Jhand. “With appropriate treatment, most people have significant symptom relief and resume their active lifestyle with improved longevity.”