What Is Aortic Stenosis?

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Medically reviewed by Rafle Fernandez, MD

Aortic stenosis is a condition that occurs when the opening of the aortic valve becomes narrowed. The aortic valve is a heart valve that helps direct blood flow from the heart to the rest of your body. When the valve becomes too narrow it limits blood flow through the heart and to the main artery (blood vessel) that supplies oxygen-rich blood to the body (the aorta). This condition can also affect the pressure within the heart’s left upper chamber (the left atrium).

Some people are born with a condition known as a bicuspid aortic valve, which can lead to aortic stenosis. But for many, this condition occurs later in life, often due to aging. An estimated 2% to 9% of people over the age of 75 years experience severe aortic stenosis. For those who experience aortic stenosis later in life, calcium buildup and scarring in the blood vessels can harm the valve. This makes it harder for blood to pass through the valve.

Aortic Stenosis Symptoms

Many people with aortic stenosis may not show any clear symptoms until the condition severely limits blood flow. For some, symptoms may not begin until after the age of 50.

When symptoms of aortic stenosis do appear they can include:

• Chest pain or discomfort
• Heart palpitations
• Shortness of breath
• Fainting
• Dizziness
• Difficulty walking or exercising without feeling exhausted
• Swelling in the ankles or feet
• Trouble sleeping unless sitting up
• Lethargy or fatigue
• Chronic cough that sometimes occurs with coughing up blood

Children who are born with a bicuspid aortic valve have a higher risk of developing aortic stenosis. If your child has this condition, they may experience the following symptoms:

• Extreme fatigue
• Difficulty gaining weight as expected
• Challenges with feeding properly
• Breathing difficulties that emerge within days or weeks after birth

Causes

Some people are born with a defect in the aortic valve, which can eventually cause aortic stenosis. For people born with a bicuspid aortic valve, your heart valve has two flaps instead of three, which increases the risk of heart valve problems. This is the most common cause for younger people with aortic stenosis.

However, if you develop this condition as you get older, several factors can contribute to the onset of symptoms. One common cause is a buildup of calcium in the valve, which can cause hard deposits in your blood vessels and limit blood from flowing effectively. Other conditions, including rare metabolic disorders, autoimmune disorders (like lupus), and end-stage kidney disease, can contribute to calcium buildup in your heart valve.

Risk Factors

Certain factors can cause a rapid decline in your heart function and increase your risk of developing symptoms of aortic stenosis, such as:

• Older age
• Calcium buildup in the heart valve
• High blood pressure
• Smoking tobacco
• Obesity
• Kidney problems
• High cholesterol
• Metabolic syndrome

Diagnosis

Aortic stenosis can worsen your heart health, so getting a timely diagnosis is essential. Diagnosing aortic stenosis usually begins with a physical exam. Your healthcare provider often detects a heart murmur, a clicking sound, or other unusual heart sounds using a stethoscope. Signs such as a weak pulse, low blood pressure, or changes in the pulse’s strength in the neck can also be signs of this condition.

To confirm a diagnosis of aortic stenosis, your healthcare provider will likely order a specific heart imaging test known as a transthoracic echocardiogram (TTE). A TTE is a non-invasive diagnostic test that uses ultrasound waves to create images of the heart. The purpose of this scan is to measure the size and performance of the heart’s four chambers.

Additional tests that your provider may order include:

• Electrocardiogram (ECG): Records the heart’s electrical activity
• Exercise stress testing: Assesses how the heart functions under physical stress
• Left cardiac catheterization: Examines the heart’s chambers and blood flow
• Heart MRI: Provides detailed images of the heart’s structure and function
• Transesophageal echocardiogram (TEE): Gives a closer look at the heart’s valves and chambers from inside the esophagus

Treatment

If symptoms are mild, regular appointments with a healthcare provider may be sufficient for monitoring aortic stenosis. During these visits, your healthcare provider may review your personal medical history, conduct a physical examination, and order an echocardiogram to review your heart health and assess the severity of your condition.

However, if you have severe aortic stenosis, your provider will often recommend that you limit strenuous physical activity and avoid competitive sports to prevent added strain to your heart. Healthcare providers also recommend managing high cholesterol and quitting smoking. However, some cases of aortic stenosis require treatment, which may include medications or surgical procedures.

Medications

Prescription medications can help manage symptoms and reduce the risk of heart failure or irregular heart rhythms, such as atrial fibrillation. Your provider may recommend one or more of the following drug types:

• Diuretics to reduce fluid buildup
• Nitrates to improve blood flow
• Beta-blockers to reduce heart strain

Managing high blood pressure is also important, but should be approached with caution. That’s because severe aortic stenosis can sometimes cause blood pressure to fall too low.

Surgical Procedures

For both adults and children who experience symptoms of aortic stenosis, surgery to repair or replace the affected valve is a common treatment option. Sometimes, even if the symptoms are mild, healthcare providers may suggest surgery based on the findings of your diagnostic testing.

There are several surgical approaches for replacing a damaged valve, including:

• Mechanical valve: Involves using a valve made from durable materials
• Tissue valve: Uses a heart valve made from human or animal donor tissue
• Ross procedure: Relocates a healthy valve in your heart to replace the damaged valve and uses a new and healthy heart valve to replace the relocated heart valve
• Balloon valvuloplasty: Inserts a balloon through an artery in the groin and into the heart to inflate and widen the valve opening
• Transcatheter aortic valve replacement (TAVR): Implants an artificial valve through a catheter

How to Prevent Aortic Stenosis

Aortic stenosis often results from age-related changes or congenital conditions (conditions that are present at birth) that cannot be completely prevented. While a healthy lifestyle (such as getting exercise, eating a low-cholesterol diet, and abstaining from cigarette smoking) may reduce some risk factors, unfortunately, the development of aortic stenosis itself may not always be avoidable.

Related Conditions

Several conditions can occur alongside aortic stenosis. These include:

• Heart failure: Your heart’s pumping ability can decrease, which affects how much blood your heart can deliver to other organs in your body
• Pulmonary hypertension: Also known as high blood pressure in the lungs, this condition can occur due to increased pressure in the heart caused by aortic stenosis
• Infective endocarditis: An infection of the heart’s inner lining or valves, which is generally more common among people with a bicuspid aortic valve

Living With Aortic Stenosis

Aortic stenosis develops when your heart’s aortic valve narrows. This is often due to calcium buildup in the heart’s aortic valve or from being born with a condition like a bicuspid aortic valve. While prevention may be a challenge, advancements in medical treatments can help manage this condition effectively. Early detection is key and implementing lifestyle factors like eating a low-cholesterol diet and quitting smoking can help manage your overall heart health.

Frequently Asked Questions

What is the life expectancy of a person with aortic stenosis?

The life expectancy for someone with aortic stenosis depends on a variety of factors. Older age, severe calcium buildup of the valve leaflets, high blood pressure, obesity, smoking, high cholesterol, kidney problems, and metabolic syndrome can make this condition progress quicker. These factors can lead to a more rapid decline in heart function, affecting the overall outlook for people with aortic stenosis.

Can aortic stenosis be cured?

Unfortunately, there is no cure for aortic stenosis currently. Instead, healthcare providers recommend medications, surgery, or lifestyle habits like eating a nutritious diet and getting moderate exercise to maintain heart health. However, researchers are still working on treatments that can potentially cure aortic stenosis in the future.

Should you take vitamin D if you have aortic stenosis?

Research has shown that in older adults with aortic stenosis, taking calcium supplements might increase the risk of needing an aortic valve replacement. However, the relationship between vitamin D intake and the risk of aortic stenosis is still being studied. If you take vitamin D or are interested in the supplement, it’s important to consult your provider before adding it to your regimen.

Read the original article on Health.com.