Aortic Stenosis Explained: Causes, Symptoms, and What to Expect

Aortic stenosis—the narrowing of the aortic valve opening—restricts blood flow from the heart to the body, forcing the heart to work harder. Over time, this can lead to heart failure, arrhythmias, and sudden cardiac death if untreated. Understanding the causes and recognizing symptoms early can lead to timely, life-saving intervention.

What Is the Aortic Valve?

The aortic valve sits between the left ventricle and the aorta. Its three leaflets open with each heartbeat to let oxygen-rich blood exit the heart, then close tightly to prevent backflow. When these leaflets become stiff, thickened, or fused, the opening narrows—this is aortic stenosis.

Common Causes

• Age-related calcific degeneration: The most common cause in adults over 65. Calcium deposits gradually stiffen the leaflets.
• Bicuspid aortic valve: A congenital condition where the valve has two leaflets instead of three. It predisposes to earlier stenosis (often 40s–60s).
• Rheumatic heart disease: Scarring from untreated strep throat (rheumatic fever) can damage the valve, though this is now rare in developed countries.
• Radiation therapy: Chest radiation for cancers like lymphoma can accelerate valve calcification decades later.
• Infective endocarditis: Bacterial infection of the valve can cause scarring and stenosis.

Symptoms: Often Silent Until Advanced

Many people have no symptoms for years. When they appear, they typically include:

• Shortness of breath, especially with activity
• Chest pain or tightness (angina)
• Dizziness, lightheadedness, or fainting (syncope)
• Fatigue and reduced exercise tolerance
• Palpitations
• Swollen ankles or feet (in later stages)

The classic triad of angina, syncope, and heart failure symptoms signals severe disease requiring urgent evaluation.

Diagnosis and Monitoring

A heart murmur heard during a routine exam is often the first clue. Echocardiography (heart ultrasound) confirms the diagnosis, assesses severity, and tracks progression. Regular follow-up is essential—even asymptomatic severe stenosis carries risk.

Treatment: Valve Replacement

No medication reverses aortic stenosis. When symptoms develop or the heart shows strain, valve replacement is indicated:

• TAVR (Transcatheter Aortic Valve Replacement): Minimally invasive, via catheter through the femoral artery. Now standard for many patients, including lower-risk ones.
• SAVR (Surgical Aortic Valve Replacement): Open-heart surgery with a mechanical or bioprosthetic valve. Preferred for certain younger patients or complex anatomy.

Living With Aortic Stenosis

If you have mild or moderate stenosis: stay active, control blood pressure and cholesterol, avoid smoking, and keep follow-up appointments. Report new symptoms promptly. With modern treatment, most people return to full, active lives.