Aortic valve stenosis — or aortic stenosis — is a type of heart valve disease (valvular heart disease). The valve between the lower left heart chamber and the body's main artery (aorta) is narrowed and doesn't open fully. This reduces or blocks blood flow from the heart to the aorta and to the rest of the body.
Treatment of aortic stenosis depends on the severity of the condition. You may need surgery to repair or replace the valve. Without treatment, severe aortic valve stenosis can lead to death.
Aortic valve stenosis ranges from mild to severe. Symptoms generally occur when narrowing of the valve is severe. Some people with aortic valve stenosis may not have symptoms for many years.
Symptoms of aortic valve stenosis may include:
- An irregular heart sound (heart murmur) heard through a stethoscope
- Chest pain (angina) or tightness with activity
- Feeling faint or dizzy or fainting with activity
- Shortness of breath, especially with activity
- Fatigue, especially during times of increased activity
- Rapid, fluttering heartbeat (palpitations)
- Not eating enough (mainly in children with aortic valve stenosis)
- Not gaining enough weight (mainly in children with aortic valve stenosis)
Aortic valve stenosis may lead to heart failure. Heart failure symptoms include fatigue, shortness of breath, and swollen ankles and feet.
When to see a doctor
If you develop symptoms that may suggest aortic valve stenosis, make an appointment with your health care provider.
To understand the causes of aortic valve stenosis, it may be helpful to know how the heart and heart valves typically work.
The heart has four valves that keep blood flowing in the correct direction:
- Aortic valve
- Mitral valve
- Tricuspid valve
- Pulmonary valve
Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly. If a valve doesn't fully open or close, blood flow is reduced or blocked.
In aortic valve stenosis, the valve between the lower left heart chamber (left ventricle) and the aorta does not open completely. The area through which blood moves out of the heart to the aorta is narrowed (stenosis).
When the aortic valve opening is narrowed, the heart must work harder to pump enough blood into the aorta and to the rest of the body. The extra work of the heart can cause the left ventricle to thicken and enlarge. Eventually the strain can cause a weakened heart muscle and can ultimately lead to heart failure and other serious problems.
Aortic valve stenosis causes include:
Congenital heart defect. Some children are born with an aortic valve that has only two cusps (bicuspid aortic valve) instead of three (tricuspid aortic valve). Rarely, an aortic valve may have one (unicuspid) or four (quadricuspid) cusps.
Having a congenital heart defect such as a bicuspid aortic valve requires regular medical checkups. The valve condition may not cause any problems until adulthood. If the valve begins to narrow or leak, it may need to be repaired or replaced.
Calcium buildup on the valve (aortic valve calcification). Calcium is a mineral found in the blood. As blood repeatedly flows over the aortic valve, calcium deposits can build up on the heart valves.
The calcium deposits may never cause any problems. Aortic valve stenosis that's related to increasing age and calcium deposit buildup usually doesn't cause symptoms until age 70 or 80. However, in some people — particularly those with congenital aortic valve defects — calcium deposits result in stiffening of the valve cusps at a younger age.
Rheumatic fever. This complication of untreated strep throat can damage the heart valves. It may cause scar tissue to form on the aortic valve. Scar tissue can narrow the aortic valve opening or create a rough surface on which calcium deposits can collect.
Rheumatic fever may damage more than one heart valve, and in more than one way. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.
Risk factors of aortic valve stenosis include:
- Older age
- Certain heart conditions present at birth (congenital heart defects), such as a bicuspid aortic valve
- Chronic kidney disease
- Having heart disease risk factors, such as diabetes, high cholesterol and high blood pressure
- History of infections that can affect the heart, such as rheumatic fever and infective endocarditis
- History of radiation therapy to the chest
Aortic valve stenosis can cause complications, including:
- Heart failure
- Blood clots
- Irregular heart rhythms (arrhythmias)
- Infections that affect the heart, such as endocarditis
Some possible ways to prevent aortic valve stenosis include:
- Taking steps to prevent rheumatic fever. See your health care provider when you have a sore throat. Strep throat can usually be easily treated with antibiotics. Untreated strep throat can develop into rheumatic fever. Rheumatic fever is more common in children and young adults.
- Keeping the heart healthy. Talk to your health care provider about risk factors for heart disease and how to prevent or manage them. They include high blood pressure, obesity and high cholesterol levels. These risk factors may be linked to aortic valve stenosis.
- Taking care of the teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and worsen aortic valve stenosis.
If you have aortic valve stenosis, your health care provider may recommend that you limit strenuous activity to avoid overworking your heart.