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About Aortic Stenosis
Also called aortic valve stenosis, aortic stenosis is a common heart valve condition where the heart’s aortic valve (one of four valves) becomes thickened and narrowed. This makes it difficult for the valve to open properly, blocking blood flow to the rest of the body. As a result, the heart works harder to pump sufficient blood. According to the American Heart Association, more than 13% of Americans over 75 years old have aortic stenosis, though it does occur in younger and pediatric patients.
Types and Stages of Aortic Stenosis
There are two main types of aortic stenosis:
- Acquired aortic stenosis occurs when aortic stenosis is an “acquired” condition that develops over time. This is the most common type of aortic stenosis in adults.
- Congenital aortic stenosis is typically present at birth in babies. It is a more common type of heart defect that affects the heart valve due to an abnormality of the valve like narrowing or leaking.
- As a result of congenital heart disease, some children have a bicuspid aortic valve, a type of abnormality in the aortic valve. Most healthy aortic valves have three flaps that open and close with each heartbeat, but a bicuspid aortic valve only has two. Learn more about our pediatric congenital heart services.
Once the type is determined, your cardiologist will classify the severity of your stenosis:
- Mild Aortic Stenosis: Usually has little to no symptoms and many dismiss these symptoms as part of aging.
- Moderate Aortic Stenosis: May also have little to no symptoms but can progress quickly into severe stenosis.
- Severe Aortic Stenosis: Recognizable symptoms that impact daily living should receive a referral to structural heart and valve program for an evaluation of treatment options. If left untreated, it can lead to a heart attack, heart failure or death.
Symptoms
Many patients with aortic stenosis have no noticeable symptoms (asymptomatic). Most patients are diagnosed once their condition has progressed, and their symptoms are more noticeable. Some symptoms include:
- Breathlessness or weakness with activity
- Heart palpitations
- Chest pain, or angina
- Light headedness or dizziness with activity
- Fainting (syncope)
If you're experiencing pressure, heaviness or pain in the chest, arm or below the breastbone alone or in combination with sweating, nausea, extreme shortness of breath or irregular heartbeats, you may be having a heart attack. Call 911 immediately.
Causes and Risk Factors
Acquired aortic stenosis is caused by:
- Getting older: As you age, calcium can build up around the aortic valve, causing it to narrow.
- Infections: Some infections like strep throat can cause rheumatic fever, which can damage the aortic valve.
- Other conditions: Aortic stenosis can be linked to conditions like endocarditis (infection in the heart caused by bacteria or fungus), chronic kidney disease, diabetes, high blood pressure, and some autoimmune diseases.
- Cancer treatments: Radiation therapy to the chest, a procedure typically used to treat cancer, has also been linked to aortic stenosis.
The cause of congenital aortic stenosis is currently unknown but may be genetic.
Diagnosing Aortic Stenosis
When you visit your healthcare provider, they may order a variety of tests based on your symptoms to confirm your diagnosis. These tests may be performed in the office or at another location, like an imaging center or cardiac catheterization lab. Tests that may be performed include:
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Physical Exam
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Chest X-Ray
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Diagnostic Cardiac Catheterization
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Echocardiogram with Doppler Echocardiography
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Electrocardiogram
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Exercise Stress Test
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Transesophageal Echocardiogram
A physical exam where your doctor listens to your heart with a stethoscope is often the first step in diagnosing aortic stenosis. Aortic stenosis often causes a heart murmur, a distinct "whooshing" or "swishing" sound that can be heard as the heart beats.
A chest x-ray shows the condition of the heart and if there is any calcium buildup on the valve. If your doctor has ordered an X-ray, it can be scheduled at a BayCare Imaging Center.
This procedure allows your cardiologist to measure the pressure on both sides of the aortic valve using a thin, flexible tube called a catheter. The catheter has sensors that can measure the pressure in the left ventricle and the aorta. The difference in pressure between the two helps diagnose aortic stenosis. The following BayCare hospitals perform diagnostic cardiac catheterizations:
This is a type of echocardiogram that still uses ultrasound technology to create detailed images of the heart in motion, but it also includes an extra “Doppler” feature that measures the speed and direction of blood flowing through the heart. It helps your doctor understand if the blood is flowing correctly through your valves. If your doctor has ordered this test, it can be performed in your cardiologist’s or primary care physician’s office or at the following BayCare hospitals:
Also known as an ECG or EKG, this test records the electrical signals in the heart to check its rhythm. Valve conditions force the heart to work harder and can cause heart rhythm issues. This test is often performed in your cardiologist’s office.
A stress test usually involves physical activity like walking on a treadmill or riding a stationary bike while the heart is monitored. It helps show how the heart responds to stress while monitoring your blood pressure, heart rate, oxygen levels, heart’s electrical activity (using an EKG), and how you feel. If extra imaging is done before and after exercise, it's called a nuclear stress test. For patients who cannot exercise safely, a pharmacological stress test may be used, where medication is given to mimic the effects of exercise on the heart. Stress tests can be performed at the following BayCare hospitals:
A transesophageal echocardiogram (TEE) is a type of echocardiogram that uses a thin tube placed down your throat (esophagus) to take detailed photos of the heart’s structures from inside your body. This method provides more detailed images because it avoids interference from other parts of your body. If your doctor has ordered this test, these can be performed at the following BayCare hospitals:
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Medications
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Open-Heart Surgery
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TAVR
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Minimally Invasive Surgery
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Balloon Valvuloplasty
Your cardiologist may prescribe medications to help manage your symptoms. Common medications include:
- Diuretics (water pills): These medications help remove excess sodium (salt) and water from your body, reducing stress on your heart.
- Heart rhythm medications: If aortic stenosis causes heart rhythm problems, medications like beta, calcium, sodium, or potassium channel blockers may also be used. These drugs help control your heart's rate and rhythm.
- Anti-hypertensive medications: These medications help control blood pressure and open blood vessels, making it easier for your heart to pump blood. Examples include angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs).
- Blood thinners: Since heart valve problems can cause poor blood circulation or pooling around the diseased valve, these medications are used to decrease the risk of blood clots and stroke.
During surgical aortic valve replacement (SAVR), a large incision is made down the middle of the chest to access the heart. A cardiovascular surgeon will either surgically replace it with a mechanical or bioprosthetic valve. This procedure requires a heart-lung machine, which pumps and oxygenates blood during surgery. Surgical aortic valve replacement is performed at these BayCare hospitals:
Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive alternative to open-heart surgery. Instead of a large incision, small incisions are made in a blood vessel, and a specialized catheter (a thin, flexible tube) with a balloon-expandable valve is inserted. Once it's positioned inside the heart, the balloon expands, placing the new valve inside the diseased one. BayCare was the first to bring TAVR technology to the Tampa Bay area. TAVR can be performed through the following BayCare structural heart and valve programs:
During a minimally invasive surgical aortic valve replacement, the surgeon uses several smaller incisions to access the heart instead of one large incision. These small incisions are often made between the ribs on your side, to the right of your breastbone or through a portion of your breastbone (sternum). A bioprosthetic or mechanical valve is used to replace the diseased valve. Special cameras or robotic equipment may also be used. This procedure requires a heart-lung machine, which pumps and oxygenates blood during surgery. Minimally invasive aortic valve replacement is performed at these BayCare hospitals:
This minimally invasive treatment uses a thin, flexible catheter (tube) with a small balloon at the end. The catheter is inserted through an incision in your groin and guided to your heart. Once inside the aortic valve, the balloon is inflated to push open and stretch the narrowed valve and the balloon and catheter are then removed. Balloon valvuloplasty is performed at these BayCare Hospitals:
Living With Aortic Stenosis
Many people with aortic stenosis live normal, healthy lives. Here are a few tips for living with this condition:
- Get regular check-ups to watch for condition progression.
- Watch out for changes in your symptoms and alert your heart specialist if they worsen.
- Discuss any exercise program with your cardiologist. Exercise can worsen symptoms and place an extra strain on your heart.
Additional Resources
Frequently Asked Questions
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If you have aortic stenosis, do you always need a new valve?For mild or moderate aortic stenosis, getting a new valve (valve replacement) is not always needed. If progression into severe aortic stenosis occurs, a new valve may be a recommended treatment. Sometimes aortic stenosis can progress quickly, so it's important to meet regularly with your cardiologist or cardiovascular surgeon to understand the state of your condition.
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What is the difference between aortic valve stenosis and aortic valve regurgitation?In aortic valve stenosis, the valve doesn't fully open and restricts blood flow. In aortic valve regurgitation, the valve doesn't close tightly and causes the blood to flow or "leak" backward. Aortic valve regurgitation is sometimes called aortic valve insufficiency.
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Does aortic stenosis need emergency treatment?There are times when treatment of aortic stenosis must be done quickly. If aortic stenosis quickly becomes severe, it can cause acute heart failure and cardiogenic shock that can lead to multiorgan failure and death. It can also cause an aortic aneurysm, a very dangerous condition that needs immediate treatment.
Aortic Stenosis Causes, Symptoms and Progression
September 14, 2022
Aortic stenosis is one of the most common and serious valve disease problems. Listen as Dr. Joshua Rovin, a cardiovascular surgeon and director of the Center for Advanced Valve and Structural Heart Care at Morton Plant Hospital, discusses the main symptoms, causes and progression of aortic stenosis.