Overview

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. The valve doesn't open fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and to the rest of your body.

Your treatment depends on the severity of your condition. You may need surgery to repair or replace the valve. Without treatment, severe aortic valve stenosis can lead to death.

Symptoms

Aortic valve stenosis ranges from mild to severe. Signs and symptoms generally occur when narrowing of the valve is severe. Some people with aortic valve stenosis may not have symptoms for many years.

Signs and symptoms of aortic valve stenosis may include:

  • Abnormal 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 when you have been active
  • 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 signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.

When to see a doctor

If you have a heart murmur, your doctor may recommend that you visit a doctor trained in diseases of the heart (cardiologist). If you develop any symptoms that may suggest aortic valve stenosis, see your doctor.

Causes

Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic 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 aortic 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, your heart must work harder to pump enough blood into the aorta and to the rest of your 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 checkups by a doctor. The valve defect 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. Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, calcium deposits can build up on the heart valves (aortic valve calcification).

    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 ages 70 or 80. However, in some people — particularly those with a congenital aortic valve defect — calcium deposits result in stiffening of the valve cusps at a younger age.

    Heart valve calcium deposits aren't linked to taking calcium tablets or drinking calcium-fortified products.

  • Rheumatic fever. This complication of strep throat infection may result in scar tissue forming 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

Risk factors of aortic valve stenosis include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve
  • History of infections that can affect the heart
  • Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
  • Chronic kidney disease
  • History of radiation therapy to the chest

Complications

Aortic valve stenosis can cause complications, including:

  • Heart failure
  • Stroke
  • Blood clots
  • Bleeding
  • Heart rhythm problems (arrhythmias)
  • Infections that affect the heart, such as endocarditis
  • Death

Prevention

Some possible ways to prevent aortic valve stenosis include:

  • Taking steps to prevent rheumatic fever. You can do this by making sure that you see your doctor when you have a sore throat. Untreated strep throat can develop into rheumatic fever. Fortunately, strep throat can usually be easily treated with antibiotics. Rheumatic fever is more common in children and young adults.
  • Addressing risk factors for coronary artery disease. These include high blood pressure, obesity and high cholesterol levels. These factors may be linked to aortic valve stenosis, so it's a good idea to keep your weight, blood pressure and cholesterol levels under control if you have aortic valve stenosis.
  • Taking care of your 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 aggravate aortic valve stenosis.

Once you know that you have aortic valve stenosis, your doctor may recommend that you limit strenuous activity to avoid overworking your heart.