Guide to Aortic Stenosis

What is Aortic Stenosis?

Aortic stenosis occurs when the heart's aortic valve narrows. The aortic valve connects the heart’s left side to the aorta, the body’s main artery. The narrowing of aortic stenosis prevents the valve from opening fully, which obstructs blood flow from the heart into the aorta and onward to the rest of the body.

When the aortic valve is obstructed, the heart needs to work harder to pump blood to the body. Eventually, this extra work limits the amount of blood it can pump and may weaken the heart muscle, leading to symptoms.

What causes Aortic Valve Stenosis?

The most common causes of aortic stenosis are:

Calcific aortic stenosis: In older adults, mild thickening or calcification of the aortic valve is a common age-related change (called aortic sclerosis). Often, the calcification will not affect the motion of the valve, but in about 2% to 3% of people over 75 years old, calcific aortic stenosis develops.
Congenital bicuspid aortic valve stenosis: the aortic valve is typically made up of three leaflets, but 1% to 2% of the population is born with a valve made up of only two leaflets. This is called a congenital bicuspid aortic valve. Of the people born with this a bicuspid valve, about half will develop aortic stenosis and up to one third will develop aortic regurgitation. Aortic stenosis caused by a congenital bicuspid aortic valve affects men more often than women.

Less common causes of aortic stenosis include other congenital conditions and rheumatic fever (a complication of untreated strep infections that are rarely seen in countries where antibiotics are readily accessible).

What are the symptoms of Aortic Stenosis?

Aortic valve stenosis is not a sudden disease, so signs and symptoms typically develop over time. When narrowing of the valve is severe, signs and symptoms can include:

Chest pain (angina) or tightness
Feeling faint or fainting with exertion
Shortness of breath, especially with exertion
Fatigue, especially during times of increased activity
Heart palpitations — sensations of a rapid, fluttering heartbeat
Heart murmur

Symptoms develop as the aortic valve becomes narrower and pressure increases inside the left heart ventricle. This causes the left heart ventricle to become thicker, which decreases blood flow and can lead to chest pain. As the pressure continues to rise, blood may back up into the lungs, which causes shortness of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause light-headedness and fainting.

How is Aortic Stenosis diagnosed?

Aortic valve stenosis may not produce warning signs right away, making it difficult to detect at first. The condition is often discovered during a routine physical when a doctor hears an abnormal heart sound (heart murmur). This murmur may occur long before other signs and symptoms develop.

Echocardiography (an ultrasound of the heart) is the gold standard in diagnosing aortic valve disease. After valvular heart disease has been diagnosed by echocardiography, catheterization may be performed to monitor pressures inside the heart as well as to check for additional coronary artery disease.

What are the treatment options for Aortic Stenosis?

Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

To date, no pills or medications exist for the treatment of aortic stenosis. High blood pressure (hypertension) occurs in up to 40% to 50% of people with calcific aortic stenosis and should be managed appropriately, because untreated hypertension may lead to earlier onset of symptoms. Blood pressure medications should be increased slowly, and vasodilators should be used with caution with severe aortic stenosis.

My doctor tells me that I have Aortic Stenosis, what should I do now?

People with aortic stenosis fall into one of four categories of severity:

Mild
Moderate
Severe
Critical

Asymptomatic patients with aortic stenosis should see a cardiologist every 3 to 6 months to monitor for changes in exercise tolerance or other symptoms. Patients should stop smoking and may be treated for high cholesterol.

A cardiologist can help determine the severity level for your aortic stenosis. If you are having symptoms, you should also consult with a cardiac surgeon to evaluate your surgical treatment options.

Our team of cardiac surgeons are here to help with your case of aortic stenosis, whether you want to discuss options, create a plan of action, or receive a second opinion.

Next Steps

If you have heart disease and need help, we’re here for you. To get started today, call (212) 305-2633 or use our appointment request form.