Understanding aortic stenosis and how symptoms may evolve over time

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If you have been diagnosed with aortic stenosis, a type of heart valve disease, you may be unfamiliar with the condition and what it may mean for your life. But that’s not unusual. In fact, the U.S. Centers for Disease Control and Prevention estimates that 75% of Americans know nothing, or almost nothing, about heart valve disease.

Learning to recognize the symptoms of aortic stenosis is especially important, as they may be subtle and easy to miss. But it is the presence of symptoms that often guides treatment and helps determine the appropriate time for a corrective heart valve procedure, according to Yogesh N. Reddy, M.B.B.S., a cardiologist and aortic stenosis expert at Mayo Clinic in Rochester, Minnesota.

“A lot of people with aortic stenosis are older and they may just blame their slowing down on aging,” says Dr. Reddy. “But if you notice there’s a change, you should get checked out to see if it is truly just age-related deconditioning or if there is a treatable cause.”

What causes aortic stenosis?

The heart uses four different valves — the tricuspid, pulmonary, mitral and aortic — to move blood through and out of the heart. These valves function like doors, swinging open to let blood flow forward, then closing to prevent blood flowing backward.

Heart valves are amazing; they are thin and almost weightless, yet they let blood pulse through the heart approximately 100,000 times a day, every day of your life.

Heart valve disease happens when one of the four heart valves becomes damaged or does not function as expected. With aortic stenosis, the opening of the aortic valve becomes too narrow. The narrowing of a valve is called stenosis. Depending on the situation, the stenosis may be mild, moderate or severe.

As a result of this narrowing, it is harder and takes more pressure for the heart to push blood through the valve. The heart’s lower left chamber, called the left ventricle, also may become thicker over time due to that increase in pressure. This thickening of the left ventricle is called hypertrophy. Over time, hypertrophy damages the left ventricle and the heart is not able to keep up with the workload of providing adequate blood supply to the body.

Aortic stenosis has a few different causes. Some people are born with heart conditions. They are called congenital heart defects. Others, typically older adults, may develop the condition due to calcium buildup on the aortic valve. An inflammatory disease caused by untreated strep throat or scarlet fever, called rheumatic fever, can lead to heart damage or scar tissue on the heart valves or increase the risk of calcium buildup. Finally, other types of heart disease can lead to valve damage.

Certain factors — including family history, older age, kidney disease, diabetes, high cholesterol and high blood pressure — can increase the risk of aortic stenosis.

Understanding the symptoms of aortic stenosis

The symptoms of aortic stenosis, and their severity, can vary. When the aortic valve narrows gradually over time, there typically aren’t any symptoms until the disease becomes more advanced. For some people, it can take years until they notice or have any symptoms.

When symptoms are present, they are often experienced during physical exertion. These symptoms may include:

• Chest pain or tightness, called angina pectoris.
• Shortness of breath, called dyspnea.
• Lightheadedness or fainting, called syncope.
• Fatigue.
• Rapid heartbeat.
• Decreased exercise tolerance.

Of all these symptoms, Dr. Reddy says fainting is often the most dangerous due to the risk of injury from falling.

How aortic stenosis symptoms may develop

Aortic stenosis is a progressive condition, meaning the disease tends to get worse over time. In some situations, it may lead to heart failure. Heart failure means the heart is unable to supply enough blood to the body. As a result, it can be life-threatening without proper treatment.

However, Dr. Reddy says it is important to keep in mind that with early detection and proper treatment, most people will not develop heart failure.

Symptoms of heart failure may include:

• Shortness of breath with activity or when lying down.
• Wheezing.
• Extreme tiredness.
• Weakness.
• Swelling in the legs, ankles, feet or belly.
• Rapid or irregular heartbeat.
• Chronic cough or a cough with white or pink mucus with blood.
• Rapid weight gain.
• Nausea.
• Lack of appetite.

Other, rarer complications of aortic stenosis may include:

• Pulmonary hypertension. This is a type of high blood pressure that affects arteries in the lungs, as well as the heart. There are treatments available, but pulmonary hypertension may be life-threatening in some situations.
• Arrhythmia. This is an irregular heartbeat. An arrhythmia may feel like a fluttering, racing or pounding in the chest. It may be caused by severe thickening of the ventricle, called hypertrophy, calcium buildup or additional heart conditions.
• Endocarditis. People with aortic stenosis are at a higher risk of developing inflammation of the valve. Without treatment, endocarditis is life-threatening.
• Risk of bleeding. People with aortic stenosis are at a higher risk of chronic intestinal bleeding, as well as increased bleeding of the skin and mucus sites, such as the nose and mouth.

How aortic stenosis develops or advances for you, and its impact on your quality of life, depends on a number of factors. Your care team will discuss your exact diagnosis with you. It’s important to keep in mind that there are options available to address heart valve disease, including medications to help manage symptoms and procedures that can repair or replace the aortic valve.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.