What Is Aortic Valve Stenosis?

Medically Reviewed by Zilpah Sheikh, MD on March 04, 2024
15 min read

Aortic valve stenosis is a blockage in one of the valves that help control the flow of blood to and from your heart.

This stenosis, or narrowing, of the valve can keep it from opening or closing all the way. With each heartbeat, less blood leaves your heart to go out and nourish the rest of your body. Over time, your heart has to work harder to pump enough blood.

Every day, about 2,000 gallons of blood circulate through your heart. Your hearthas four valves that open and close in a steady rhythm to send all that blood throughout your body.

The aortic valve is the last valve the blood passes through before leaving your heart. By the time blood gets to this valve, it’s been through your lungs and picked up another round of oxygen for your body.

The aortic valve's job is to pump this blood from your lower left heart chamber into your aorta, the large blood vessel that carries blood out to your body. The valve has three flaps, called leaflets or cusps. These flaps open to let blood through, then close again to keep the blood from flowing back into your heart.

When your aortic valve doesn't open normally, your heart can’t pump all the blood that builds up inside it. This can cause blood to back up elsewhere in your heart, and even into your lungs. To make up for this problem, your heart muscle pumps harder.

This extra work can eventually cause the lower left heart chamber (left ventricle) to get thicker and larger. This may weaken your heart muscle and cause other types of heart damage, such as heart failure.

Several conditions can cause aortic valve stenosis, also called aortic stenosis. Among them are:

Calcium buildup

Your blood carries calcium, among other minerals and nutrients. As blood passes through your aortic valve year after year, calcium deposits may form on the valve. This can make it stiffer, preventing it from fully opening.

Heart defect from birth

A normal aortic valve has three flaps, or cusps, which fit snugly together. Some people are born with an aortic valve that has one, two, or even four cusps. Your heart can function just fine this way for years.

But as you move into adulthood, the abnormal valve is more likely to get stiffer and not open as well as it should. This type of heart defect can be treated by repairing or replacing the valve.

Rheumatic fever

Though this complication from strep throat or scarlet fever isn’t nearly as common as it once was, it can still pose a threat. Rheumatic fever can scar your aortic valve. Scar tissue makes it easier for calcium to build up.

Doctors classify aortic valve stenosis as mild, moderate, or severe. Which stage you have depends on how damaged your aortic valve is and how much blood can pass through it. Not everyone whose condition is at the same stage will have the same symptoms or need the same treatments.

Mild aortic valve stenosis

Aortic stenosis doesn't always affect your health right away. Many people who have mild cases don't notice any symptoms.

As your aortic valve’s opening slowly shrinks, the heart muscle picks up the slack. It can take many years for this extra work to cause serious damage to your heart muscle.

The most common early warning signs are:

  • Physical activity takes more effort.
  • You feel tired all the time
  • In a child or infant, chest pain after exercise

Because these symptoms are so subtle, most people find out they have a mild case during a checkup. When your doctor listens to your heart, they may hear an abnormal whooshing sound between heartbeats. Called a heart murmur, this distinct sound can show up long before other aortic stenosis symptoms.

Moderate aortic valve stenosis

You can have a slightly more advanced case of aortic stenosis but still not show any symptoms. Or, you may start to feel the effects of the extra stress on your heart.

If your condition is moderate, you may notice:

  • You often feel out of breath, especially when you’re active
  • Chest pain
  • Tightness or pressure in your chest
  • A fast heartbeat (palpitations)
  • Exercise feels harder

Severe aortic valve stenosis

Over time, your aortic valve opening can shrink from the size of a nickel to about the size of the head of a golf tee. This causes further wear and tear on your heart.

When you have severe aortic stenosis, you may have the same symptoms as some people with moderate cases, such as chest pain or tightness, shortness of breath, and fainting. These signs can also mean your condition is starting to worsen more quickly.

Some people, especially older ones, show no symptoms despite having a severe case. The only warning you may have is less energy when you exercise or do physical work. Doctors call this asymptomatic aortic stenosis.

Because the signs of this condition vary so much, your doctor will want to do tests to see how well your heart is working. Your treatment will be based on your symptoms as well as what these tests show.

You can have aortic valve stenosis for a long time before you notice any symptoms. It's easy to overlook gradual signs of a weakening heart, especially at first.

Symptoms of this condition include:

  • Shortness of breath, especially during exercise
  • Chest pain or tightness that gets worse when you exercise and can spread to your neck, jaw, belly, or arm
  • Feeling dizzy or lightheaded
  • Fainting
  • Fatigue
  • Heart palpitations (rapid or fluttering heartbeat)
  • Heart murmur (an extra beat between your usual heartbeats)
  • Swelling in your ankles, feet, lower legs, or ankles

Sometimes, a family member or a friend will notice a change in your behavior or energy level before you do.

In children, the symptoms include:

  • Getting tired easily when they're physically active
  • Lack of appetite
  • Gaining too little weight as they grow
  • Breathing problems that may show up shortly after birth

Their condition may get worse as they get older.

How fast does the condition progress?

How quickly aortic valve stenosis progresses varies from person to person, depending on things like how healthy you are, what stage of aortic stenosis you have, and what treatment you get. It sometimes takes years. Things that can worsen it more quickly include:

  • Older age
  • Having excess weight or obesity
  • Smoking 
  • Having high cholesterol, high blood pressure, or metabolic syndrome

Even if you don't have serious symptoms, it's important to get the right diagnosis and treatment. if you wait too long, you risk permanent damage to your heart.

The main risk factor for aortic valve stenosis is being over 65. Calcium buildup on the valve tends to happen over many years.

Other risk factors include:

  • A history of infections that can affect the heart, such as rheumatic fever or infective endocarditis
  • Chronic kidney disease
  • Heart problems you were born with, such as an abnormal aortic valve
  • A history of radiation treatment to your chest
  • Risk factors for heart disease such as high blood pressure, high cholesterol, and diabetes
  • Autoimmune diseases such as lupus and rheumatoid arthritis (RA)
  • Certain other conditions, including Paget's disease of the bone and familial hypercholesterolemia (hereditary high cholesterol)

Some of the complications that can result from an overworked heart include:

  • Chest pain caused by poor blood flow to the heart muscle
  • Fainting because you aren’t getting enough blood to your brain
  • Heart failure -- a weakened heart that doesn’t pump well
  • Arrhythmias -- abnormal heart rhythms caused by irregular blood flow through the heart
  • Blood clots
  • Infections that affect your heart, such as endocarditis
  • Stroke

Some of these complications can be serious or even fatal.

For many people, a routine checkup reveals the first sign of aortic valve stenosis. A doctor listening to your heart with a stethoscope may hear a “whooshing” sound or extra heartbeat that indicates a heart murmur. A heart murmur is often a sign of valve trouble, but not always.

After a full exam and a review of your medical history, your doctor may order a few tests. They include:

  • Echocardiogram: This imaging test uses sound waves to create a picture of your heart’s structure. An echocardiogram can often tell whether your aortic valve has narrowed.
  • X-ray: This is another type of imaging test that uses electromagnetic energy beams to produce images of the inside of your chest. It lets your doctor see whether your heart is enlarged, and if there's buildup on your aortic valve. 
  • CT scan: This test combines multiple X-ray images to give your doctor provide a more detailed cross-section view of your heart.
  • MRI scan: This test uses a strong magnetic field to create images of your heart. It can show the size of your aorta, which can help your doctor see how serious your condition is.
  • Electrocardiogram (EKG): This measures electrical activity in the heart. It can help your doctor find out where there's been any heart failure, which may have been caused by aortic valve stenosis.
  • Exercise stress test: During the test, you walk quickly on a treadmill or ride a stationary bicycle to increase your heart rate. If you don’t have symptoms, seeing how your heart responds to exercise can help your doctor diagnose aortic valve stenosis, as well as other heart problems.
  • Cardiac catheterization: If there's insufficient evidence to confirm aortic valve stenosis, your doctor may recommend this procedure. To do it, your doctor threads a thin, flexible tube into your arm to inject a dye, which shows up on an X-ray “movie,” giving a more detailed look at your heart’s valves and chambers.

If you don't have any symptoms and your heart is otherwise healthy, you may not need treatment. Your doctor might just keep tabs on your condition with regular checkups and testing.

If you develop complications such as high blood pressure or arrhythmia, your doctor may prescribe medication to treat them. These may include:

  • Blood pressure medications such as ACE inhibitors or beta-blockers
  • Drugs to manage an abnormal heart rhythm
  • Diuretics to reduce fluid buildup 

Medications for blood pressure or to control your heart rhythm won’t reverse aortic valve stenosis, but they will help keep your heart as healthy as possible.

When drugs aren’t enough to keep things in check, you may need surgery to repair or replace your aortic valve.

Even if you don't have symptoms, you could need a procedure to repair or replace a seriously damaged heart valve.

Aortic valve replacement

This procedure is done with mechanical valves made of metal or with valve tissue from cows, pigs, or human donors. Your doctor may replace the valve using traditional open-heart surgery, during which they make a cut down your chest wall and open your rib cage.

Transcatheter aortic valve replacement

Another replacement option is a catheter procedure called transcatheter aortic valve replacement (TAVR). TAVR is less invasive, which means your surgeon uses much smaller cuts than with open-heart surgery. People usually have an easier time recovering and have less discomfort with this procedure.

Which option you and your doctor choose depends on the details of your specific case.

Balloon valvuloplasty

This procedure is most often done in infants and kids with aortic valve stenosis. It’s less effective for adults.

In the procedure, a doctor guides a catheter (a long, flexible tube) through a blood vessel and into the heart. At the tip of the catheter is a deflated balloon. When the tip reaches the valve, the balloon is inflated, pushing open the stiff valve and stretching the cusps.

Aortic valve repair

Doctors can also repair an aortic valve with surgery to separate cusps that have fused together. But in most cases, the valve needs to be replaced entirely.

Your recovery depends on what type of procedure you had and how healthy you were before the procedure. You can expect:

  • To stay in the hospital for several hours to several days so doctors can monitor how you're doing. You might go home within 1 day if you had TAVR. But for open-heart valve replacement, the average stay is 5-7 days.
  • Your health care team will keep tabs on your vital signs and your pain level. They'll also urge you to get up and move around as soon as you're able to do so.
  • Your doctor may want you to have cardiac rehab to help you recover.

After an open-heart procedure:

  • You’ll be in an intensive care unit (ICU). You’ll wake up in an ICU, probably with a breathing tube in your throat. The tube comes out as soon as your doctors are sure you’re breathing well on your own. That’s usually within a couple of hours. You’ll get pain medicine to help keep you comfortable.
  • You’ll need to do deep breathing and coughing to clear your lungs. This is an important part of your recovery, but it can hurt after surgery. You’ll probably get a pillow to hold to your chest to help ease the pain.
  • Staff will track all your vital signs. You’ll hear a lot of beeping machines.
  • When you’re ready, you’ll move from the ICU to another area of the hospital. This is sometimes called a step-down unit. You can usually have more visitors once you’ve moved.

Within days after having heart valve replacement surgery, you should be spending more and more time out of bed. You’ll be eating and drinking, going to the bathroom, and taking short walks around the hospital.

If you have drainage tubes in your chest, those come out a day or so after surgery. The process may be slightly painful but shouldn’t be too bad.

Before you go home, you should be spending most of the day out of bed. Some hospitals set specific goals -- such as walking 150 feet and climbing a flight of stairs -- that you must reach first.

At home

Whether you had surgery or TAVR, you’ll need someone to drive you home and help care for you during the first part of your recovery.

Your doctors will let you know how to care for your surgical cuts, or “incisions.” It should be OK to take a shower but you'll probably need to avoid baths for a couple of weeks.

Activity is an important part of your recovery. It’s good to gradually push your limits. Your doctor will give you guidelines on ramping up your exercise. You’ll need to avoid lifting heavy objects for the first few weeks.

You may feel some pain in your chest, back, neck, or shoulders. If your appetite is off or food tastes strange, that’s normal. Your body might have trouble controlling your temperature, so you could feel unusually hot or cold at times. These are all symptoms that will go away.

Your sleep may not be great after surgery. That’s common. And you might need a nap in the middle of the day for the first few weeks you’re home. Your energy level should gradually get better.

If you’re very aware of your heartbeat, that’s normal. If you have a mechanical replacement valve, you may hear a clicking sound in your chest. That’s just the valve opening and closing.

Here's what to expect as you recover in the weeks after your heart valve procedure:

  • Driving. Your doctor will help you decide when it’s safe to drive again, usually 1-4 weeks after your procedure. If you had open-heart surgery, your breastbone is healing and will be vulnerable in an accident.
  • Work. When you can go back to work depends on how your recovery is going and how demanding your job is. You might be able to return in 2 weeks after TAVR, or in 3-4 weeks after open-heart surgery. Or you might need to take more time.
  • Sex. As with any other physical activity, you can start having sex again when you feel well enough. Be cautious about trying to support your weight on your arms, though.
  • Depression. Some people become depressed during recovery from a heart procedure. Staying active can help. But you should let your doctor know of any concerns about your moods. Even a few sessions of counseling might help, and there are medicines for this.
  • Diet. Your doctor may give you a specific diet to follow. If not, eating in a way that’s heart-healthy -- lots of vegetables, lean proteins, whole grains instead of processed grains (think brown rice instead of white), and limiting added sugars, sodium, and saturated fats -- is good for your whole body.
  • Exercise. Your doctor will give you guidelines on exercise. You'll need to avoid heavy lifting and strenuous activities for several days. Once you're well enough, aim for at least 150 minutes of activity a week. That’s 30 minutes a day, 5 days a week.

You can’t always stop aortic valve stenosis from happening. For instance, there’s nothing you can do about a heart defect you were born with. But high blood pressure, high cholesterol, and obesity are linked to aortic valve stenosis, and those are issues you have some control over. Your doctor can advise you on ways to manage all of these conditions.

Good dental hygiene also helps. Serious gum disease may be linked to heart inflammation.

And if you ever have strep throat, be sure to treat it with a full round of antibiotics to prevent it from becoming rheumatic fever. If you get rheumatic fever, it can also be treated with antibiotics.

The better you can manage some of these issues and the earlier you act on your symptoms, the lower are your chances of developing valve problems.

In addition to your doctor's treatment plan, you can take steps to keep your heart as healthy as you can. The goal is to manage the condition well.

Attend all your planned doctor visits. How often you check in with your doctor will depend on the symptoms you have and how advanced your condition is. If it’s moderate or severe, you may need to see your cardiologist twice a year. If it’s mild, you may need only a yearly exam and an echocardiogram every 1 or 2 years.

Take your meds. Follow your doctor’s orders and take any drugs exactly as prescribed. These medicines can help keep your heart from working too hard and prevent blood clots and infections.

Stay active, but be safe. Working out is good for your heart, even if you have aortic stenosis. First, check with your doctor about whether there are any physical activities you should avoid. You’ll also want to know how long your heart rate can safely be raised and whether you need to track how high it gets during a workout.

Ask questions. Notice new or changing symptoms? Don’t ignore them. Call your doctor, and discuss any concerns you have.

Care for your teeth and gums. Aortic stenosis raises your risk for infective endocarditis, a severe infection of the heart lining and valves. It’s caused by bacteria that get into your bloodstream, often through your gums. To prevent this, brush your teeth twice each day and get regular cleanings. Let your dentist know that you have aortic stenosis.

Don’t put off surgery. Your doctor may advise a procedure to repair or replace your damaged valve. This may sound daunting, but most people find that their symptoms improve afterward. Without treatment, your chance of heart failure will rise.

Get support. If a heart condition makes you feel anxious or depressed, talking about these concerns may make you feel better. Confide in loved ones, or ask your doctor to refer you to a counselor.

Get to a healthy weight. Being overweight or obese puts strain on your heart, especially if most of your fat is around your waist. Writing down the foods you eat and when you exercise, or entering this info into an app, can help you spot unhealthy patterns.

Manage your stress. Everyone feels anger, sadness, and anxiety from time to time. But if these feelings are out of control, it can take a toll on your emotional and physical health. Find healthy ways to relax, such as exercise, meditation or prayer, spending time with loved ones, and laughing more. Talking with a counselor can also help.

Watch what you eat. Aim for a diet that’s rich in whole grains, lean protein, fruits, and vegetables. Eating more meals at home will help you build better eating habits. When you can, avoid highly processed foods. Many products that come in a bag or box tend to have sodium, sugar, and unhealthy fats.

Manage other health conditions. If you also have diabetes and/or other types of heart disease, make it a priority to take care of those conditions.

Cut down on drinking. Alcohol can raise the level of some fats in your blood. It can also boost your blood pressure and add strain to your heart. Limit yourself to no more than one or two glasses of beer or wine a day, depending on your size.

Quit smoking. The chemicals in tobacco smoke harm your blood vessels and keep your heart from working as well as it should. Talk to your doctor about ways you can break this habit. Many hospitals and local community groups offer free classes or support groups that can help.