Aortic Stenosis

What Is Aortic Stenosis?

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Updated on February 23, 2023
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Aortic stenosis, also known as aortic valve stenosis, is a type of heart valve disease in which the heart’s aortic valve narrows, preventing it from opening fully. This interferes with regular blood flow from the heart to the aorta (the main artery of the body) and to the rest of the body, causing the heart to work harder than usual.

Treatment for aortic stenosis depends on the condition’s severity, but it can include medication or valve replacement. When left untreated, aortic stenosis can lead to heart damage and potentially life-threatening complications.

Signs and Symptoms of Aortic Stenosis

Not everyone with aortic stenosis has noticeable symptoms. Some people may not experience symptoms until the amount of restricted blood flow is significant. In any case, signs of the disease can range from mild to severe.

Symptoms of aortic stenosis include:

  • Chest pain
  • Breathlessness or trouble breathing
  • Fainting, dizziness, or feeling lightheaded
  • Rapid, fluttering heartbeat
  • Swollen feet or ankles
  • Becoming tired quickly during normal activities, including walking
  • Trouble sleeping

If you do experience symptoms, see your doctor, who can determine the severity of the aortic stenosis and check for reduced heart function.

Infants and children may develop aortic stenosis due to a congenital defect (birth defect). Those symptoms include:

  • Inability to gain weight
  • Fatigue during normal activities
  • Difficulty feeding
  • Trouble breathing

Causes and Risk Factors of Aortic Stenosis

There are many causes of aortic stenosis. These include:

  • Calcium buildup: In older adults, scarring and calcium buildup can damage the valve, restricting blood flow.

  • Congenital problems: Young people may experience aortic stenosis because of a congenital heart defect called bicuspid aortic valve, in which only two valve cusps (flaps or folds) develop instead of the usual three.
  • Rheumatic fever: A complication of untreated strep throat, rheumatic fever can cause scar tissue to form on the aortic valve and narrow the valve’s opening.

Risk Factors

Risk factors for aortic stenosis include:

  • Aging
  • Congenital heart disease
  • Infections that affect the heart
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Chronic kidney disease
  • Radiation therapy to the chest

How Is Aortic Stenosis Diagnosed?

Your doctor will begin by asking you about your symptoms, reviewing your medical history, and performing a physical exam, which includes listening to your heart through a stethoscope.

Next, your healthcare provider may order tests to help make an aortic stenosis diagnosis. These tests may include:

  • Echocardiogram: By using sound waves to make a picture of your heart, this imaging test shows your doctor how well your heart valves are working.
  • Electrocardiogram: This test measures electrical activity in the heart.
  • Chest X-ray: These images can show your doctor whether your heart and aorta are enlarged and if you have calcium buildup on your aortic valve.
  • Exercise test: Checking your physical fitness can help doctors determine if you have symptoms of aortic valve disease.
  • Cardiac computerized tomography scan: This test compiles a series of X-rays to create detailed images of your heart.
  • Cardiac magnetic resonance imaging: Magnetic fields and radio waves create detailed pictures of your heart that can help determine the severity of your condition.

Treatment and Medication Options for Aortic Stenosis

The best course of treatment for aortic stenosis depends on your disease progression. If your symptoms are mild, your healthcare provider may keep an eye on your condition with regular appointments. They may also recommend heart-healthy lifestyle changes and certain medications. If your aortic stenosis is severe, treatment options may include replacing the aortic valve.

Medication Options

Your doctor may prescribe drugs to alleviate your symptoms and help prevent further problems, especially if your condition is mild or you can’t have surgery.

These medications may include:

  • Anti-arrhythmic medications to keep your heart rhythm normal when arrhythmias (irregular heartbeats) develop
  • Anticoagulants or blood thinners to reduce the risk of blood clots
  • Beta-blockers to decrease the heart’s workload and reduce palpitations
  • ACE inhibitors to decrease blood pressure when hypertension is present
  • Diuretics to reduce the amount of fluid in the tissues and the bloodstream
  • Vasodilators to open and relax the blood vessels

Surgery

Surgical options to treat aortic valve stenosis include:

 
  • Aortic valve replacement: Aortic valve replacement is frequently needed to treat aortic valve stenosis. The surgery involves removing the damaged valve and replacing it with a mechanical valve or a valve made from cow, pig, or human heart tissue. If you have a mechanical valve, you must take blood-thinning medications for the rest of your life to prevent blood clots.
  • Transcatheter aortic valve replacement: Transcatheter aortic valve replacement (TAVR) is a less invasive procedure in which doctors use a catheter to replace an aortic valve that has narrowed. TAVR may be the best option if you’re at high risk of complications from surgical aortic valve replacement.
  • Aortic valve repair: In rare cases, surgeons repair an aortic valve by separating valve flaps that are stuck together. 
  • Balloon valvuloplasty: To treat aortic valve stenosis in infants and children, doctors may insert a catheter with a balloon on the tip into a blood vessel and guide it to the aortic valve. They then inflate the balloon, which expands the opening of the narrowed valve. For adults, this procedure is typically only performed on those who are too sick to manage a more invasive surgery like aortic valve replacement.

Prevention of Aortic Stenosis

While nothing can be done to prevent congenital aortic stenosis present at birth, there are steps you can take to avoid developing the condition in the future.

Aortic stenosis may be prevented by:

  • Promoting heart health: High blood pressure, obesity, and high cholesterol levels may be linked to aortic stenosis, so it’s important to keep your blood pressure, weight, and cholesterol levels in check.
  • Maintaining good oral hygiene: Infected gums may lead to a heart infection called endocarditis, which is a risk factor for aortic stenosis.
  • Avoiding rheumatic fever: See your doctor if you have a sore throat. Left untreated, strep throat can develop into rheumatic fever, which can cause aortic stenosis.

Prognosis and Outlook for Aortic Stenosis

Individuals with mild aortic stenosis may not experience significant symptoms, meaning they could go years without realizing they have the disease. More severe cases may result in serious complications and should be addressed as soon as possible.

Severe cases of aortic stenosis can progress quickly, resulting in a life expectancy of only a few years. However, appropriate treatment for aortic stenosis has yielded successful results, so it’s important to maintain regular check-ins with your doctor.

Complications of Aortic Stenosis

Potential complications associated with aortic stenosis include:

  • Blood clots
  • Bleeding
  • Heart failure
  • Stroke
  • Irregular heartbeat
  • Infections that affect the heart

Research and Statistics: Who Has Aortic Stenosis?

Aortic stenosis is most commonly diagnosed in older adults, and more than 13 percent of Americans ages 75 and older have the condition.

 While some research has indicated that aortic stenosis occurs more often in men than women, emerging reports question that assertion. More research is needed to determine the prevalence of aortic stenosis between the sexes.

The condition is significantly less common in individuals under 65, but it can appear as a congenital heart defect in infants. However, the incidence of congenital aortic valve stenosis is low, with a rate of 3.8 to 4.9 per 10,000 live births.

Disparities in Aortic Stenosis

Aortic stenosis may be underdiagnosed in certain racial and ethnic minority groups. According to a 2022 research article, non-Hispanic white Americans have a greater likelihood of receiving an aortic stenosis diagnosis following transthoracic echocardiography. Meanwhile, non-Hispanic Black Americans and non-Hispanic Asian Americans are less likely to receive an aortic stenosis diagnosis after having a transthoracic echocardiography.

Additionally, a study published in 2024 found racial and ethnic disparities in individuals receiving aortic valve replacements. Out of almost 300,000 Medicare beneficiaries hospitalized with a principal aortic stenosis diagnosis, Black Americans, Hispanic Americans, and Asian Americans were all less likely to receive aortic valve replacements than white Americans.

Related Conditions and Causes of Aortic Stenosis

Many people with aortic stenosis also have other cardiac conditions, including:

  • Coronary artery disease: This occurs when there is a narrowing or blockage of the arteries that supply blood to the heart.

  • Hypertension: Also known as high blood pressure, this happens when blood consistently pushes too hard against your artery walls.

  • Atrial fibrillation: Also known as afib, this is a common type of arrhythmia that results in an irregular or often rapid heart beat.

The Takeaway

  • Aortic stenosis is a heart valve condition that occurs when the aortic valve narrows, preventing blood from flowing normally.
  • Symptoms of aortic stenosis can include chest pain, trouble breathing, fainting, and rapid heartbeat.
  • When left untreated, aortic stenosis can result in life-threatening complications, so it’s important to seek medical attention right away if you experience symptoms.
  • Treatment for aortic stenosis depends on your condition’s severity, but it may include medication or surgery.

Common Questions & Answers

How serious is aortic stenosis?
Aortic stenosis can be a life-threatening condition. Left unaddressed, aortic stenosis can lead to heart damage, significant health problems, and death.
The best treatment for aortic stenosis depends on your condition, but aortic valve replacements have proven to be an effective surgical remedy.
Symptoms of aortic stenosis might include chest pain, rapid heartbeat, trouble breathing, dizziness, difficulty walking short distances, and an inability to do normal activities. However, aortic stenosis may not always show symptoms, so it’s important to schedule regular doctor’s visits.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  2. Aortic Stenosis Overview. American Heart Association. May 23, 2024.
  3. Medications for Heart Valve Symptoms. American Heart Association. May 30, 2024.
  4. Aortic Valve Stenosis. Penn Medicine.
  5. Aortic Stenosis. Cleveland Clinic. September 4, 2024.
  6. Aortic Stenosis. American Heart Association. October 2024.
  7. DesJardin JT et al. Sex Differences and Similarities in Valvular Heart Disease. Circulation Research. February 18, 2022.
  8. Yasuhara J et al. Congenital Aortic Valve Stenosis: From Pathophysiology to Molecular Genetics and the Need for Novel Therapeutics. Frontiers in Cardiovascular Medicine. April 28, 2023.
  9. Crousillat DR et al. Racial and Ethnic Differences in the Clinical Diagnosis of Aortic Stenosis. Journal of the American Heart Association. December 20, 2022.
  10. Gupta A et al. Racial/Ethnic Disparities in Aortic Valve Replacement Among Medicare Beneficiaries in the United States, 2012–2019. The American Journal of Medicine. April 2024.
  11. Perpétuo L et al. Coronary Artery Disease and Aortic Valve Stenosis: A Urine Proteomics Study. International Journal of Molecular Sciences. November 5, 2022.
  12. Coronary Artery Disease. Cleveland Clinic. October 13, 2023.
  13. Basile C et al. Arterial Hypertension in Aortic Valve Stenosis: A Critical Update. Journal of Clinical Medicine. November 26, 2021.
  14. Niemi HJ et al. Impact of Atrial Fibrillation on the Symptoms and Echocardiographic Evaluation of Patients With Aortic Stenosis. The American Journal of Cardiology. January 15, 2024.
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Chung Yoon, MD

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Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys clinical decision-making and providing patient care in both hospital and outpatient settings. He excels at analytical and decision-making skills and building connection and trust with patients and their families.
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