Aortic Valve Stenosis
Aortic Valve Stenosis: A Complete Patient 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.
Aortic stenosis develops when the aortic valve becomes stiff and its opening narrows. In the UK the commonest cause is age-related calcification of the valve, but some people are born with a valve that is more likely to narrow earlier in life.
Calcific degeneration (age-related)
This is the most common cause in adults. Over decades, calcium and scar tissue build up on the valve leaflets and make them stiff, a process that shares features with the one that causes coronary artery disease. It usually becomes significant after the age of 65 and is more common with increasing age.
Bicuspid aortic valve
About 1 to 2 in 100 people are born with two valve leaflets instead of three. A bicuspid valve is more likely to become stiff and narrowed, often in the 40s to 60s, a decade or more earlier than a normal valve. It runs in families, so close relatives are usually offered a screening echocardiogram. See our page on bicuspid aortic valve.
Rheumatic heart disease
Scarring after rheumatic fever in childhood can narrow the aortic valve, usually together with other valve problems. It is now uncommon in the UK but more frequent in people who grew up in parts of the world where rheumatic fever is common.
Risk factors that speed up valve calcification
High blood pressure.
High cholesterol, including raised lipoprotein(a), an inherited cholesterol particle.
Diabetes and metabolic syndrome.
Smoking.
Chronic kidney disease.
Previous radiotherapy to the chest.
Male sex and increasing age.
How is severity graded?
Echocardiography measures how fast blood flows across the valve and the size of the valve opening. Stenosis is generally classed as severe when the peak velocity is 4 m/s or more, the mean pressure gradient is 40 mmHg or more, or the valve area is 1.0 cm² or less. Mild and moderate stenosis are monitored, and severe stenosis is assessed for treatment.
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.
We offer a private echocardiogram in Peterborough, Corby and London.
Tests and services that may help
We can arrange the assessments used to diagnose and monitor aortic stenosis:
Echocardiogram, the key test for measuring valve narrowing and heart function
Exercise ECG (treadmill test) and stress echocardiogram to check how your heart responds to exercise when you have no symptoms
CT coronary angiogram (CTCA) to look at the coronary arteries before valve treatment
Cardiac MRI where echo findings are unclear
ECG reporting, UK-wide, and cardiac monitoring for palpitations or dizziness
Consultation by telephone, video or face to face
If you have chest pain, fainting or severe breathlessness, call 999 rather than waiting for an appointment.
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.
Driving, work and travel
Based on DVLA guidance last updated 7 November 2025:
Car and motorcycle (Group 1): heart valve disease does not need to be reported to the DVLA, but if you have aortic stenosis with fainting, near-fainting or symptoms likely to affect safe driving, you must stop driving and tell the DVLA.
After valve surgery: do not drive for 4 weeks (2 weeks after a transcatheter procedure such as TAVI).
Bus, coach and lorry (Group 2): severe aortic stenosis means you must stop and tell the DVLA. Relicensing needs an exercise test and annual review.
Work and travel: people with mild or moderate stenosis can usually work and fly normally. If your stenosis is severe or you have symptoms, discuss flying, travel insurance and physically demanding work with your cardiologist first. Rules change, so always check GOV.UK, and see our DVLA cardiac assessment page if you drive for work.
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.
Guidelines and sources
This page follows current UK and European guidance:
NICE NG208: Heart valve disease presenting in adulthood: care and treatment.
Praz F et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2025;46:4635-4736.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
These are the questions patients most often ask about aortic valve stenosis.
I have been told I have a heart murmur. Does that mean aortic stenosis?
Not necessarily. Many murmurs are harmless, particularly in younger people. However, a murmur in an older adult may be the first sign of aortic stenosis, so an echocardiogram is the best way to find out. See our echocardiogram page.
Can I have severe aortic stenosis and feel fine?
Yes. The heart compensates for years, so symptoms may only appear when the valve is already severely narrowed. Some people unconsciously reduce their activity and only notice how breathless they were after treatment. If you are being monitored, report any new breathlessness, chest tightness, dizziness or fainting promptly.
How often will I need follow-up scans?
Typically about every 3 to 5 years for mild stenosis, every 1 to 2 years for moderate stenosis, and every 6 to 12 months for severe stenosis. Your cardiologist may scan sooner if your symptoms change or the valve is progressing quickly.
Is there any medicine that can fix or slow aortic stenosis?
No medicine has been shown to stop the valve narrowing. Medicines are used to treat related problems such as high blood pressure, high cholesterol and fluid retention. The definitive treatment for severe stenosis is to replace the valve.
When does the valve need to be replaced?
Replacement is recommended when severe stenosis causes symptoms, because outcomes without treatment are poor once symptoms appear. It is also advised for severe stenosis without symptoms in some situations, such as a weakened pumping function, an abnormal exercise test or rapid progression. Recent trials of earlier treatment in selected people without symptoms have shown benefit, and the 2025 European guideline has widened the options, but this is an individual decision for you and your heart team.
What is the difference between TAVI and open-heart surgery?
Surgical valve replacement (SAVR) replaces the valve through open-heart surgery. TAVI (transcatheter aortic valve implantation) places a new valve inside the old one through a small tube, usually from an artery in the groin, without stopping the heart. The 2025 ESC/EACTS guideline favours TAVI for most people aged 70 and over with a standard three-leaflet valve, whereas surgery is often preferred for younger patients, for some bicuspid valves and when other heart surgery is needed. The choice is made by a heart team after scans of your valve, aorta and coronary arteries.
How long is the recovery after TAVI or valve surgery?
After TAVI, many people go home within one to three days and are back to normal activities within a few weeks. After open-heart surgery, hospital stay is usually about a week and full recovery takes around 6 to 12 weeks. Cardiac rehabilitation is recommended.
Will I need blood-thinning tablets after valve replacement?
It depends on the valve. A mechanical valve needs lifelong warfarin. A tissue (biological) valve, including a TAVI valve, usually needs only short-term antithrombotic treatment, and some people also take aspirin. If you also have atrial fibrillation you may need an anticoagulant. Your cardiologist will give you a plan.
Is it safe to exercise with aortic stenosis?
Light to moderate regular activity such as walking is generally encouraged. If you have symptoms or severe stenosis, avoid heavy lifting, competitive sport and sudden strenuous effort until you have been assessed. A supervised exercise test can help to define what is safe for you.
Do I need antibiotics before dental treatment?
Good dental hygiene and regular dental checks matter, because endocarditis (infection of the valve) is a serious risk. NICE does not recommend routine antibiotics before dental procedures, whereas the European guideline advises them before high-risk dental procedures in people with a replacement valve. Ask your cardiologist which applies to you, and tell your dentist about your valve.
Can I have an operation or anaesthetic with aortic stenosis?
Many people can, but severe stenosis raises the risk of non-cardiac surgery. Tell your surgeon and anaesthetist about your valve disease, and ask whether a valve procedure should come first.
Is aortic stenosis hereditary?
Age-related calcification is not usually inherited in a simple way, but a bicuspid valve runs in families. If you have a bicuspid valve, your parents, brothers, sisters and children are usually advised to have a screening echocardiogram.
What is the outlook if I am treated?
After valve replacement, symptoms usually improve substantially and life expectancy is close to that of people of the same age. Without treatment, severe symptomatic stenosis has a poor outlook, which is why timely assessment is important.
When should I see a cardiologist?
See a cardiologist if you have a murmur, new breathlessness, chest tightness, dizziness or fainting, or if you have been told you have aortic stenosis and want a specialist opinion on monitoring or the timing of treatment. You can arrange a telephone, video or face-to-face consultation.
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?
What happens in aortic stenosis?
A healthy aortic valve compared with a narrowed, calcified (stenotic) aortic valve, seen from above.
In aortic stenosis the valve becomes stiff and narrow, so the heart has to work harder to push blood through it. Over time this can cause breathlessness, chest tightness, dizziness or fainting.
From symptoms to treatment
The usual pathway from symptoms to valve replacement.
Once severe aortic stenosis causes symptoms, replacing the valve is the treatment that improves survival. A heart team will explain whether open surgery or a keyhole-style procedure (TAVI) is better for you.
If you have an aortic valve problem and develop chest pain, fainting or collapse, or severe breathlessness, call 999 immediately.
If you have a heart murmur or have been told you have aortic stenosis, you may benefit from a telephone consultation or video consultation to discuss your symptoms and results, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as echocardiography, ECG reporting, exercise ECG, exercise stress echo and CT coronary angiography (CTCA) may be recommended to further evaluate your valve and heart.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.