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Overview
What is aortic stenosis?
The aorta is the main artery that carries blood out of the heart to the rest of the body. Blood flows out of the heart and into the aorta through the aortic valve. In people with aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart. As the aortic valve narrows, the left ventricle must work harder to pump blood out through the valve. To do this extra work, the muscles in the ventricle walls become thicker. Untreated aortic stenosis has major health consequences that includes chest pain, congestive heart failure, passing out spells, arrhythmias and death.
Aortic stenosis may be present at birth (congenital), but most often it develops later in life. Children with aortic stenosis may have other conditions present from birth.
Classic, typical Aortic stenosis develops later in life mainly from the buildup of calcium deposits that reduce movement of the valve and narrow the opening. This is called calcific aortic stenosis and affects older people. Aortic stenosis occurs in about 2% of people over 65 years of age. It occurs more often in men than in women.
Calcium buildup of the valve can occur sooner in people who are born with abnormal aortic or bicuspid valves. In rare cases, calcium buildup can develop more quickly when a person has received chest radiation (such as for cancer treatment). Another cause is rheumatic fever. This condition can develop after strep throat or scarlet fever. Valve problems do not develop for 5 to 10 years or longer after rheumatic fever occurs. Rheumatic fever is rare in the United States.
What are symptoms of aortic stenosis?
Most people with aortic stenosis do not develop symptoms until the disease is advanced. The diagnosis may have been made when the health care provider heard a heart murmur and performed tests before any symptoms developed.
Symptoms of aortic stenosis include:
- Chest discomfort: The chest pain may get worse with activity and reach into the arm, neck or jaw. The chest may also feel tight or squeezed.
- Fainting, weakness or dizziness with activity
- Breathing problems either at rest or when exercising
- Swelling of the feet, legs or abdomen
- Waking up short of breath after falling asleep
- Fluid in the lungs
- Cough, possibly bloody
- Fainting, weakness and dizziness
- Palpitations (sensation of the heart beating)
- Fluid retention and difficulty breathing
- Becoming easily tired with activity
In infants and children, symptoms include:
- Becoming easily tired with exertion (in mild cases)
- Failure to gain weight
- Poor feeding
- Serious breathing problems that develop within days or weeks of birth (in severe cases)
Children with mild or moderate aortic stenosis may get worse as they get older. They are also at risk for a heart infection called bacterial endocarditis.
How doctors diagnose aortic stenosis
A heart murmur, click or other abnormal sound is almost always heard through a stethoscope. The provider may be able to feel a vibration or movement when placing a hand over the heart. There may be a faint pulse or changes in the quality of the pulse in the neck. Blood pressure may also be low.
Aortic stenosis is most often diagnosed and then monitored using a test called a transthoracic echocardiogram (TTE). The following tests may also be performed:
- Electrocardiogram (ECG)
- Transesophageal echocardiogram (TEE)
- Exercise stress testing
- Left cardiac catheterization
Aortic stenosis treatment and medication
Regular checkups by a provider may be all that is needed if you have no symptoms or if your symptoms are not severe. The provider should ask about your health history, do a physical exam and perform an echocardiogram. People with severe aortic stenosis may be told not to play competitive sports, even if they have no symptoms. If symptoms do occur, strenuous activity must often be limited.
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Aortic valve replacement
Replacing the valve is done for adults or children who develop symptoms due to well-documented aortic stenosis. Even if symptoms are not very bad, the provider may recommend replacement based on test results.
Until recently, the only way to replace the aortic valve was with open heart surgery. A novel catheter-based approach is now available and growing in usage and is called TAVR for transcatheter aortic valve replacement. This is a minimally invasive procedure using a catheter to deliver the new valve inside the defective one. In this procedure your physician replaces the aortic valve using a catheter, most commonly through the largest artery in your leg, without the need for open heart surgery.
Minimally invasive procedures may not be appropriate for all patients, but your cardiothoracic surgeon and cardiologist will work closely together and recommend whether surgery or TAVR is the best approach to valve replacement for you based on your individual circumstances.
In general, the long-term results of aortic valve replacement with both approaches are excellent.
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Balloon Valvuloplasty as temporary treatment
Another catheter-based invasive procedure called balloon valvuloplasty may be done to treat acutely ill patients who have severe or critical AS. Using catheters through the large artery in your leg, a balloon is threaded to the heart, placed across the valve and inflated. This basically crushes the sticky valve open and can be very effective in immediately treating debilitating AS.
However, this procedure does not permanently fix aortic stenosis as re-narrowing of the valve within 6 months is very common. Therefore, aortic valvuloplasty is used as a temporizing measure when patients who are very sick need time to bed stabilized before undergoing definitive valve replacement with either surgery or TAVR.
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Medication
Medicines are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates and beta-blockers. High blood pressure should also be treated. If aortic stenosis is severe, this all treatments must be done carefully so blood pressure does not drop too far.
Aortic stenosis treatment near you
Cardiology services at Ballad Health
Our extensive network of highly trained cardiologists, surgeons and advanced practice providers are here to support you and help you navigate a heart-related diagnosis.
Learn more about heart and vascular services at Ballad Health.
CVA Heart Institute Learning Center
We understand that receiving an aortic stenosis diagnosis can be overwhelming. Our goal is to alleviate your fears and help you to understand your condition.
We have an informational video library, education tools and heart-related FAQs so that you have the resources you need.
Heart care patient stories
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Read our patient stories
Our patients inspire us every day, and we’re honored when they trust us with their care. They tell their stories best, so we’ve gathered a few here to share with you.
Many of these patients received life-saving care for heart conditions when they weren’t experiencing any symptoms. These experiences have changed they way they look at their individual care and helped them see the importance of regular preventive screenings.