What is the aortic valve? What is aortic valve stenosis?

The heart has four chambers. In the lower left chamber (left ventricle), the aortic valve works like a one-way gate. When the heart pumps, the aortic valve opens to let oxygen-rich blood flow from the left ventricle into a large blood vessel called the aorta. Blood then flows through the aorta to the rest of the body.

Aortic valve stenosis means that this valve has narrowed, and it can't open all the way. The heart has to work harder to pump blood through the smaller opening. The heart can do this for many years, but over time it gets worn out. It can no longer send out as much blood as your body needs. If you don't get treatment, heart failure may develop.

What causes aortic valve stenosis?

Problems that can cause aortic valve stenosis include:

• Calcium buildup on the aortic valve. As you age, calcium can build up on the valve, making it hard and thick. This buildup happens over time, so symptoms usually don't appear until after age 65. Many of the same things that increase your risk for hardening of the arteries (atherosclerosis) make you more likely to have aortic valve stenosis. They include smoking, being male, or having high cholesterol, high blood pressure, or diabetes.
• A heart defect you were born with (congenital). Some babies are born with an aortic valve that has only two flaps instead of the normal three. This is called a bicuspid valve, and it makes a smaller opening for blood to flow through. In this case, symptoms usually start around age 40.
• Rheumatic fever or endocarditis. These infections can damage the valve.

What are the symptoms?

Aortic valve stenosis is a slow process. For many years, even decades, you will not feel any symptoms. But at some point, the valve will likely become so narrow (often one-fourth of its normal size) that you start having problems.

As aortic valve stenosis gets worse, you may have symptoms such as:

• Chest pain (angina). You may have a heavy, tight feeling in your chest. Chest pain is often brought on by exercise, when the heart has to work harder.
• Feeling dizzy or faint, often after you have been active.
• Feeling tired and being short of breath when you are active.
• A fast, slow, or uneven heartbeat (arrhythmia).
• A feeling that your heart is pounding, racing, or beating unevenly (palpitations).

If you start to notice any of these symptoms, let your doctor know right away. If you have symptoms, you need treatment. By the time you have symptoms, your condition probably is serious. If you have symptoms, you also have a high risk of sudden death.¹

How is aortic valve stenosis diagnosed?