Aortic Valve Stenosis
Aortic Valve stenosis: patient's guide
Aortic valve stenosis (AVS), often simply called aortic stenosis, is one of the most common and serious heart valve conditions seen in adults, particularly in people over the age of 65. The aortic valve sits between the left ventricle (the main pumping chamber of the heart) and the aorta (the largest blood vessel in the body, carrying oxygen-rich blood to all organs and tissues).
In a healthy heart, this valve opens fully with each heartbeat to allow blood to flow freely into the aorta. In aortic valve stenosis, the valve becomes narrowed, stiff, or obstructed, preventing it from opening properly. This narrowing forces the heart to pump harder to push blood through the smaller opening. Over time, the heart muscle thickens, weakens, and symptoms such as breathlessness, chest pain, fainting, and heart failure can develop.
The condition may progress slowly over many years, or in some cases, worsen more rapidly. Because symptoms often develop gradually and may be mistaken for “normal ageing,” diagnosis can sometimes be delayed until the condition is advanced. Early recognition and proper cardiology care are vital.
Aortic valve stenosis may remain “silent” for years, meaning patients may have no noticeable symptoms until the narrowing becomes severe. However, when symptoms do appear, they are usually a sign that the heart is under significant strain.
Common Symptoms:
Breathlessness (Dyspnoea): Especially on exertion or when lying flat.
Chest pain or tightness (Angina): Often triggered by activity.
Dizziness or fainting (Syncope): Especially during exertion when the heart cannot increase blood output adequately.
Palpitations: Feeling that the heart is racing, pounding, or irregular.
Fatigue: Feeling unusually tired even with mild exertion.
Swollen ankles or feet: A sign of fluid retention due to heart failure.
Heart murmur: Often detected by a doctor before symptoms appear.
Less Common Symptoms:
Difficulty exercising
Cold hands and feet due to poor circulation
Rapid weight gain from fluid retention
It’s important to note that symptoms often appear late in the disease process, meaning patients may feel well for years until the valve is critically narrowed.
You should see your GP or a cardiologist if you experience:
Chest pain, pressure, or tightness, especially with activity
Unexplained fainting or dizziness
Breathlessness that is new or worsening
Fatigue or reduced exercise tolerance
Swelling in your ankles, legs, or abdomen
Additionally, if you have been told you have a heart murmur, you should follow up with your doctor, as this may be the first clue to aortic stenosis.
Emergency Situation:
Call 999 immediately if you develop:
Sudden severe chest pain
Fainting episodes
Severe shortness of breath or difficulty breathing
Diagnosis of aortic valve stenosis involves a combination of clinical examination and specialist cardiac tests.
1. Medical History & Examination:
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Listening for a characteristic heart murmur (harsh, mid-systolic sound).
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Assessing symptoms and risk factors such as age, rheumatic fever history, or congenital heart disease.
2. Specialist Cardiac Tests:
Echocardiogram (Echo): The gold standard test. Uses ultrasound to measure valve structure, blood flow, and pressure gradient.
Electrocardiogram (ECG): Records heart rhythm and may show thickening of the left ventricle.
Chest X-ray: May show an enlarged heart or calcification of the aortic valve.
Cardiac MRI or CT scan: Provides detailed imaging of the heart and aortic root.
Cardiac catheterisation: Sometimes used before surgery or TAVI (Transcatheter Aortic Valve Implantation) to assess severity and coronary arteries.
Exercise stress testing: To assess functional capacity and symptom onset.
Treatment depends on severity, symptoms, age, and general health.
1. Watchful Waiting (Mild/Moderate Stenosis):
Regular monitoring with echocardiograms (every 6–12 months if severe, less often if mild).
Lifestyle modification: heart-healthy diet, exercise (as tolerated), avoiding smoking.
2. Medications:
No drug can “cure” aortic stenosis.
Medications may help manage symptoms and associated conditions:
Diuretics (to reduce fluid retention)
Beta-blockers or ACE inhibitors (for blood pressure and heart failure)
Statins (to lower cholesterol, though they do not reverse valve narrowing)
3. Surgical Options:
Surgical Aortic Valve Replacement (SAVR): Traditional open-heart surgery, replacing the valve with a mechanical or biological prosthetic.
Transcatheter Aortic Valve Implantation (TAVI / TAVR): A minimally invasive procedure, especially useful in older or high-risk patients.
Balloon Valvuloplasty: Temporary widening of the valve, mainly used in young patients or as a bridge to surgery.
4. Valve Choice in Replacement
Mechanical valves: Very durable, but require lifelong anticoagulation (warfarin).
Biological valves (tissue valves): Do not require long-term anticoagulation but may wear out sooner (10–20 years).
Patients diagnosed with aortic stenosis need to adapt lifestyle habits to protect heart health.
Lifestyle Tips for aortic stenosis:
Regular follow-up: Keep all cardiology appointments.
Exercise: Light to moderate activity may be beneficial; avoid strenuous exercise if symptomatic.
Diet: Heart-healthy eating (low in salt, saturated fat, and sugar).
Smoking: Stop completely – smoking accelerates heart disease.
Alcohol: Moderate intake only.
Vaccinations: Annual flu vaccine and pneumococcal vaccine recommended.
Mental Health and Support
Anxiety and depression are common after diagnosis.
Support groups and cardiac rehabilitation programmes can help.
The outlook depends on the severity of stenosis and whether treatment is performed.
Mild/Moderate disease: Patients may remain stable for many years.
Severe untreated stenosis: Average survival after symptom onset is poor – around 2 years with heart failure, 3 years with fainting, and 5 years with chest pain.
With surgery or TAVI: Survival and quality of life improve dramatically, often returning close to normal.
Aortic stenosis is the most common valve disease in developed countries.
It usually affects people over 65, but can occur earlier due to congenital bicuspid valves.
The main symptoms are chest pain, breathlessness, and fainting.
Symptoms often appear late, when the valve is already severely narrowed.
Echocardiography is the key test for diagnosis.
There is no medication that cures aortic stenosis – surgery or TAVI is needed in severe cases.
Untreated severe stenosis has a poor prognosis once symptoms develop.
TAVI offers a less invasive alternative to surgery, especially in elderly or high-risk patients.
Valve replacement restores life expectancy in most patients.
Regular monitoring is essential, even if you feel well.
How severe is my aortic valve stenosis?
How often do I need follow-up tests?
What symptoms should I watch out for that mean my condition is worsening?
Am I a candidate for TAVI or surgical valve replacement?
What are the risks and benefits of surgery compared to TAVI?
Which valve type (mechanical vs tissue) is best for me?
What lifestyle changes should I make to protect my heart?
Can I exercise safely, and if so, how much?
What medications will I need before and after treatment?
What is my long-term prognosis with and without treatment?
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