Understanding Aortic Stenosis: A Complete Guide for Patients

Aortic stenosis represents one of the most common heart valve conditions, affecting millions of people worldwide. This condition occurs when the aortic valve (the gateway between your heart's main pumping chamber and the body's largest artery) becomes narrowed and restricts blood flow.

What Happens in Aortic Stenosis

Your aortic valve normally opens wide to allow blood to flow freely from the left ventricle to the aorta and throughout your body. In aortic stenosis, this valve becomes progressively narrower, forcing your heart to work harder to pump blood through the restricted opening.

The most common cause is age-related calcific degeneration, where calcium deposits gradually accumulate on the valve leaflets over time. This process typically affects the normal three-leaflet valve structure. Some people are born with a bicuspid aortic valve (having only two leaflets instead of three), which tends to develop stenosis earlier in life. In certain regions of the world, rheumatic heart disease from untreated strep throat infections can also cause this condition.

Who Develops Aortic Stenosis

Several factors increase your risk of developing this condition. Age is the primary risk factor, with the condition becoming more common after age 65. Men develop aortic stenosis more frequently than women. Other risk factors include high blood pressure, diabetes, smoking, coronary artery disease, elevated lipoprotein(a) levels, and kidney disease.

Aortic sclerosis (early thickening of the valve without significant narrowing) affects about 25% of adults over 65. Each year, approximately 2% of people with aortic sclerosis progress to aortic stenosis.

Recognizing the Symptoms

Aortic stenosis often develops slowly over many years without causing symptoms. Once symptoms appear, they typically include shortness of breath during physical activity, chest pain or pressure (angina), and fainting or near-fainting episodes (syncope). These symptoms occur because your heart can no longer pump enough blood to meet your body's needs during exertion.

The appearance of symptoms marks a turning point in the disease. Without treatment, people with symptomatic severe aortic stenosis face a significantly worsened outlook, with up to 50% mortality within one year.

How Doctors Diagnose Aortic Stenosis

Echocardiography serves as the primary diagnostic tool for aortic stenosis. This ultrasound-based test allows doctors to see the valve structure, measure how well the leaflets move, and calculate the severity of narrowing.

Doctors classify aortic stenosis severity using specific measurements. Severe aortic stenosis is defined by an aortic jet velocity of 4 meters per second or higher, a mean pressure gradient of 40 mm Hg or greater, or a valve area of 1.0 cm² or smaller.

Once diagnosed, regular monitoring becomes important. Patients with mild aortic stenosis typically need follow-up every 3-5 years, those with moderate stenosis every 1-2 years, and those with severe stenosis every 6-12 months.

Treatment Options and Management

Currently, no medications can slow or reverse the progression of aortic stenosis. Managing other cardiovascular risk factors such as high blood pressure, high cholesterol, and smoking cessation helps maintain overall heart health but does not change the course of the valve disease itself.

Aortic valve replacement provides the definitive treatment for severe aortic stenosis. Two main approaches exist: surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The choice between these procedures depends on your age, overall health, other medical conditions, and surgical risk.

Current guidelines recommend valve replacement for all patients with symptomatic severe aortic stenosis. Certain asymptomatic patients with severe stenosis may also benefit from valve replacement, particularly those with reduced heart function or very severe stenosis.

When to Seek Treatment

The timing of intervention proves critical in aortic stenosis management. If you experience symptoms such as shortness of breath, chest pain, or fainting episodes, you should discuss these with your healthcare provider promptly. Even without symptoms, regular monitoring allows your medical team to track disease progression and recommend treatment at the optimal time.

Modern valve replacement procedures have transformed the outlook for people with aortic stenosis. These interventions can restore normal life expectancy and eliminate symptoms when performed at the appropriate time.

Living with Aortic Stenosis

If you have been diagnosed with aortic stenosis, maintaining regular follow-up care with your cardiologist remains important. Staying physically active within the limits recommended by your doctor, maintaining a heart-healthy diet, and managing other medical conditions all contribute to your overall well-being.

Understanding your condition empowers you to recognize important symptoms and seek timely treatment. With proper monitoring and appropriate intervention, people with aortic stenosis can maintain excellent quality of life and normal longevity.

This article was written by Dr. Damian Rasch to help patients understand aortic stenosis and its management. While comprehensive, it is intended for educational purposes only and does not constitute medical advice. Always discuss your specific situation with your healthcare provider.

Published by damianrasch.com