Aortic stenosis Narrowing of the aortic heart valve

What aortic stenosis is

The aortic valve is the gate between your heart’s main pumping chamber and the aorta, the large artery carrying blood to the rest of your body. It should open wide with every beat.

In aortic stenosis, that valve becomes thickened, stiff, and narrowed. The opening shrinks, and the heart has to generate much more pressure to push blood through it. Over time, the heart muscle thickens in response, and eventually it can’t keep up.

Severity is graded as mild, moderate, or severe, based on measurements taken during an ultrasound of the heart. Many people live for years with mild or moderate stenosis and never need anything beyond periodic monitoring.

Symptoms

Aortic stenosis is often silent for a long time. The heart compensates well, and people frequently adjust their activity without realizing they’re doing it.

When symptoms appear, the classic three are:

• Breathlessness

  With exertion, and later at rest.

• Chest tightness or pressure

  Brought on by activity and relieved by rest.

• Dizziness or fainting

  Particularly during or just after exertion.

• Other symptoms

  Unusual fatigue, reduced exercise tolerance, and palpitations.

The appearance of symptoms is significant. In severe aortic stenosis, symptoms mark a clear change in outlook, and it’s the point at which valve replacement is usually recommended. If you have known aortic stenosis and any of these develop, tell your doctor promptly rather than waiting for your next scheduled review.

Causes

1. 01

   Age-related calcification

   The most common cause. Calcium gradually deposits on the valve over decades, stiffening it. This is why aortic stenosis is predominantly a condition of people over 65.

2. 02

   Bicuspid aortic valve

   Roughly one to two percent of people are born with a valve that has two leaflets instead of three. It works adequately for years but wears out faster, and stenosis often develops earlier, sometimes in the forties or fifties.

   It can run in families, which is why relatives are sometimes screened.

3. 03

   Rheumatic heart disease

   Damage following rheumatic fever, now uncommon in Canada but seen in people who grew up elsewhere or who had rheumatic fever decades ago.

   Risk factors overlapping with vascular disease, including high cholesterol, high blood pressure, smoking, diabetes, and kidney disease, appear to accelerate calcification.

How it’s diagnosed

1. 01

   A murmur is usually the first sign

   Aortic stenosis produces a characteristic sound your doctor hears with a stethoscope, often during a routine examination when you feel entirely well. That’s frequently how it’s found.

2. 02

   Echocardiogram

   This is the definitive test. An ultrasound of the heart shows the valve directly, measures how fast blood is moving through it and the pressure difference across it, calculates the effective valve opening area, and assesses how the heart muscle has responded. It establishes both whether you have aortic stenosis and how severe it is.

3. 03

   ECG

   Records electrical activity and often shows thickening of the main pumping chamber.

4. 04

   Further testing when relevant

   Exercise testing is sometimes used in people who appear to have severe stenosis but report no symptoms, to see how they respond under controlled conditions. CT scanning is used in planning valve replacement.

Monitoring and treatment

There is no medication that reverses or slows aortic stenosis. This is important to understand, because it differs from most heart conditions. Medications are used to manage blood pressure, cholesterol, and other conditions alongside it, but they don’t fix the valve.

• Monitoring

  For mild or moderate stenosis without symptoms, the approach is periodic echocardiography to track progression, typically every three to five years for mild disease and every one to two years for moderate, though intervals are individualized. Many people never progress to needing intervention.

• Valve replacement

  When stenosis becomes severe and symptoms appear, replacing the valve is the treatment, and it’s highly effective. Two approaches exist.

  • Surgical aortic valve replacement

    Open heart surgery to remove and replace the valve, using either a mechanical valve or a tissue valve.

  • TAVI

    A replacement valve delivered through a catheter, usually via an artery in the groin, without opening the chest. Recovery is considerably faster. Originally developed for people too high-risk for surgery, it’s now used across a widening range of patients.

  Which is appropriate depends on your age, other health conditions, valve anatomy, and preference. That decision is made with a specialist team, and the assessment at our clinic is often the step that starts it.

• Staying active

  Most people with mild or moderate stenosis can and should remain active. Guidance on exercise in severe stenosis is more specific and should come from your cardiologist rather than from general advice.

What to expect at your appointment

Your first visit is a consultation with a cardiologist, lasting roughly an hour, and typically includes or leads directly to an echocardiogram.

Comparing previous echocardiogram reports shows how quickly the valve is changing, which is genuinely useful.

A letter goes back to your referring doctor, usually within 1 to 7 days.