Aortic Stenosis

What is aortic stenosis?

Aortic stenosis is a narrowing of the aortic valve, one of the four valves inside the heart. The aortic valve sits between the heart’s main pumping chamber (the left ventricle) and the aorta, the large artery that carries oxygen-rich blood to the rest of the body. When this valve becomes stiff, thickened, or partially fused, it cannot open fully. The heart then has to work harder to push blood through the narrowed opening, and over time this extra workload can strain and weaken the heart muscle.

Many people first ask a simple question: what is aortic stenosis in everyday terms? A useful way to picture it is a door that no longer swings all the way open. Blood still gets through, but less easily, and the pumping chamber behind the door has to push harder with every heartbeat. In the medical coding system used by hospitals, this condition is recorded as ICD-10 code I35.0, which refers to nonrheumatic aortic valve stenosis.

Aortic stenosis is one of the most common valve diseases in adults, and it becomes more frequent with age. It is often diagnosed in people over 65, usually because of gradual wear and calcium buildup on the valve. However, it can also affect younger adults, particularly those born with a valve that has two leaflets instead of the usual three (a bicuspid aortic valve). The condition typically develops slowly over many years, which is why regular follow-up is so important once it has been identified.

Symptoms of aortic stenosis

Aortic stenosis symptoms often appear gradually, and many people have no symptoms at all in the early stages. In mild or moderate disease, the heart can usually compensate for the narrowed valve, so the condition may only be discovered when a doctor hears a heart murmur (an extra whooshing sound) during a routine examination.

As the narrowing becomes more severe, symptoms tend to emerge, especially during physical activity. Common aortic stenosis symptoms include:

• Chest pain or tightness (angina): a pressure-like discomfort, often triggered by exertion and relieved by rest.
• Shortness of breath: at first only with activity, but in advanced disease also at rest or when lying flat.
• Dizziness or fainting (syncope): feeling lightheaded or actually passing out, particularly during or shortly after exercise.
• Fatigue: unusual tiredness or reduced ability to keep up with normal activities.
• Palpitations: an awareness of a rapid, fluttering, or pounding heartbeat.
• Heart murmur: not something you feel yourself, but a sound your doctor may detect with a stethoscope.
• Swollen ankles or feet: a possible sign that the heart is struggling to pump effectively (heart failure).

The stage of the disease matters a great deal. In the asymptomatic stage, the valve is narrowed but the person feels well; doctors usually monitor the condition with regular checkups and imaging. Once symptoms such as chest pain, fainting, or breathlessness develop in severe aortic stenosis, the outlook changes, and doctors generally consider this a signal that the valve needs to be repaired or replaced rather than simply watched. In infants and children with congenital (present from birth) aortic stenosis, symptoms can look different and may include poor feeding, poor weight gain, or tiring easily, which is why pediatric cases are evaluated separately.

It is worth noting that symptom severity does not always match how narrow the valve is. Some people with significant narrowing feel relatively well because they have unconsciously reduced their activity levels. This is one reason doctors ask detailed questions about what you can and cannot do compared with a year or two ago.

Causes and risk factors

Understanding aortic stenosis causes helps explain who is most likely to develop the condition. The three main causes are:

• Age-related calcification: the most common cause in older adults. Over decades, calcium deposits build up on the valve leaflets, making them stiff and less able to open. This process is sometimes called degenerative or calcific aortic stenosis.
• Congenital valve abnormalities: some people are born with a bicuspid aortic valve, which has two leaflets instead of three. This valve tends to wear out faster and often becomes narrowed earlier in life, sometimes in a person’s 40s, 50s, or 60s.
• Rheumatic fever: a complication of untreated streptococcal throat infection that can scar heart valves. Rheumatic valve disease has become less common in many countries but remains an important cause worldwide. (Rheumatic cases are coded differently from I35.0, which covers nonrheumatic stenosis.)

Several factors can increase the risk of developing aortic stenosis or speed up its progression:

• Older age, since valve calcification accumulates over time.
• High blood pressure (hypertension), which adds stress to the heart and valves.
• High cholesterol, which is associated with valve calcification in some studies.
• Diabetes and chronic kidney disease, both linked to faster calcium buildup.
• Smoking, which contributes to cardiovascular disease in general.
• Previous chest radiation therapy, for example as part of cancer treatment, which can damage heart valves years later.
• Family history of bicuspid aortic valve or early valve disease.

Many of these risk factors overlap with the risk factors for coronary artery disease (narrowing of the heart’s own arteries), and the two conditions frequently occur together. Managing blood pressure, cholesterol, and other cardiovascular risks is generally recommended, although it is important to be honest here: there is currently no medication proven to reverse or reliably stop valve narrowing once it has begun.

Diagnosis of aortic stenosis

Aortic stenosis diagnosis usually begins with a physical examination. A characteristic heart murmur, heard best over the right upper chest and sometimes radiating toward the neck, often prompts further testing. Your doctor will also ask about symptoms such as breathlessness, chest discomfort, and fainting, and about how your exercise tolerance has changed over time.

The key tests doctors use to confirm and grade aortic stenosis include:

• Echocardiogram (heart ultrasound): this is the main diagnostic test. It uses sound waves to create moving images of the heart, showing how the valve leaflets move, how narrow the opening is, and how fast blood travels through it. Doctors measure the valve area and the pressure difference (gradient) across the valve to classify the stenosis as mild, moderate, or severe. The echocardiogram also shows how well the left ventricle is pumping.
• Electrocardiogram (ECG or EKG): records the heart’s electrical activity and may show signs of thickened heart muscle or rhythm problems.
• Chest X-ray: can reveal an enlarged heart, calcium on the valve, or fluid in the lungs.
• Exercise (stress) testing: in selected patients who report no symptoms, a carefully supervised exercise test may be used to see whether symptoms or blood pressure changes appear with exertion. It is generally avoided in people who already have clear symptoms of severe stenosis.
• Cardiac CT scan: can measure the amount of calcium on the valve and is often used when planning valve procedures, because it maps the anatomy of the valve and surrounding blood vessels in detail.
• Cardiac catheterization: a thin tube (catheter) is guided through a blood vessel to the heart. It can directly measure pressures inside the heart and is commonly used before valve surgery to check whether the coronary arteries are also narrowed.

Grading matters because it guides treatment decisions. Doctors combine the valve measurements from imaging with your symptoms and overall heart function to decide whether monitoring is enough or whether it is time to intervene. If your stenosis is mild or moderate and you feel well, your doctor may recommend repeat echocardiograms at regular intervals, often every one to two years for moderate disease and less frequently for mild disease, adjusted to your individual situation.

Treatment options for aortic stenosis

Aortic stenosis treatment depends on how severe the narrowing is, whether you have symptoms, how well your heart is pumping, and your overall health. Care is typically coordinated by heart specialists; at Acibadem, for example, this condition is evaluated and managed within the Cardiology Department, working together with cardiac surgeons when a procedure is needed. The main approaches are:

Watchful waiting (active monitoring)

If the stenosis is mild or moderate and you have no symptoms, doctors usually recommend regular follow-up rather than immediate intervention. This involves periodic echocardiograms and clinic visits to track how the valve is changing. Watchful waiting is not the same as doing nothing: it is a deliberate strategy to time any procedure correctly, because replacing a valve too early carries its own risks, while waiting too long after symptoms begin can be dangerous.

Medications

It is important to understand that no medication can widen a narrowed aortic valve or remove calcium from it. Medications are used to manage related problems and symptoms, for example:

• Blood pressure medicines, used cautiously, to reduce strain on the heart.
• Diuretics (water pills) to relieve fluid buildup if heart failure develops.
• Medicines to control heart rhythm problems such as atrial fibrillation, if present.
• Statins and other treatments for cholesterol and general cardiovascular risk.

Your doctor may adjust or avoid certain medications in severe stenosis, because some drugs that lower blood pressure sharply can be poorly tolerated when the valve is very narrow.

Transcatheter aortic valve replacement (TAVR/TAVI)

Transcatheter aortic valve replacement, often abbreviated TAVR or TAVI, is a less invasive procedure in which a new valve is delivered through a catheter, usually inserted through an artery in the groin, and expanded inside the old, narrowed valve. It does not require opening the chest, and recovery is often faster than after open surgery. TAVR was originally developed for patients considered too high-risk for surgery, but its use has expanded, and in many centers it is now offered to a broader range of patients after careful evaluation by a heart team.

Surgical aortic valve replacement (SAVR)

In surgical aortic valve replacement, the diseased valve is removed through open-heart surgery and replaced with either a mechanical valve (made of durable synthetic materials) or a biological (tissue) valve. Mechanical valves generally last longer but require lifelong blood-thinning medication; tissue valves usually do not require long-term blood thinners but may wear out over time and need replacement later. The choice between valve types, and between surgery and TAVR, depends on your age, anatomy, other health conditions, and personal preferences, and is best made in discussion with a multidisciplinary heart team.

Balloon valvuloplasty

In this procedure, a balloon on a catheter is inflated inside the narrowed valve to stretch it open. In adults, the improvement is usually temporary, so it is mainly used as a bridge to valve replacement or to relieve symptoms in selected situations. In children and young adults with congenital stenosis, balloon valvuloplasty can play a larger role.

Once symptoms appear in severe aortic stenosis, guidelines generally recommend valve replacement rather than continued observation, because untreated symptomatic severe stenosis carries a serious risk of heart failure and sudden cardiac events. The exact timing and method are individual decisions made with your care team.

Living with aortic stenosis and outlook

The outlook for aortic stenosis varies widely depending on the stage at diagnosis and whether treatment is needed. People with mild disease often live for many years without symptoms, provided they attend regular follow-up so that any progression is caught early. Once the stenosis becomes severe and symptomatic, the prognosis without valve replacement is generally poor, which is why doctors take new symptoms so seriously. After successful valve replacement, many people experience substantial relief of symptoms and can return to an active life, although recovery time and long-term outcomes differ from person to person.

Practical steps that are commonly recommended for people living with aortic stenosis include:

• Keeping all scheduled follow-up appointments and echocardiograms, even when you feel well.
• Reporting new or worsening symptoms — breathlessness, chest discomfort, dizziness, fainting — promptly rather than waiting for the next visit.
• Managing blood pressure, cholesterol, diabetes, and weight with your doctor’s guidance.
• Not smoking, and limiting alcohol as advised.
• Asking your doctor which levels of physical activity are safe for your stage of disease; moderate activity is often encouraged in milder disease, while strenuous or competitive exercise may be restricted in severe stenosis.
• Maintaining good dental hygiene and telling your dentist about your valve condition, since certain heart valve problems can increase the risk of valve infection (endocarditis). Your doctor will advise whether preventive antibiotics are needed before dental work; they are not required for everyone.

Honest expectations matter. Aortic stenosis is a progressive mechanical problem, and valve replacement treats the valve rather than curing the underlying tendency toward calcification. Replaced valves, particularly tissue valves, can wear over time, so lifelong cardiology follow-up remains important even after a successful procedure.

Frequently asked questions

What is aortic stenosis in simple terms?

Aortic stenosis is a narrowing of the valve between the heart’s main pumping chamber and the body’s main artery. Because the valve does not open fully, the heart must push harder to move blood through it. Over years, this extra strain can thicken and eventually weaken the heart muscle, which is why the condition is monitored closely and treated when it becomes severe.

Can aortic stenosis heal on its own or be reversed with medication?

No. Once the valve has become significantly narrowed, it does not heal on its own, and no medication has been proven to reverse the narrowing or dissolve the calcium deposits. Medicines can help manage blood pressure, fluid buildup, and related conditions, but the definitive treatment for severe aortic stenosis is replacing the valve, either with a catheter-based procedure or open surgery.

How serious is aortic stenosis?

It depends heavily on the stage. Mild and moderate stenosis often cause no symptoms and may remain stable for years under regular monitoring. Severe stenosis with symptoms such as chest pain, fainting, or breathlessness is a serious condition that carries real risks if left untreated, which is why doctors usually recommend valve replacement at that point rather than continued observation.

What are the first warning signs of aortic stenosis?

Early on there may be no signs at all, and the condition is often first suspected when a doctor hears a heart murmur. When symptoms do appear, the earliest ones are often breathlessness or unusual tiredness during activities that used to feel easy, followed in some people by chest tightness on exertion or episodes of lightheadedness. Any fainting episode deserves prompt medical evaluation.

What is the difference between TAVR and open-heart surgery?

Both replace the narrowed valve, but by different routes. TAVR (transcatheter aortic valve replacement) delivers a new valve through a thin tube inserted into a blood vessel, usually in the groin, without opening the chest, and recovery is often quicker. Surgical replacement is an open-heart operation in which the old valve is removed and a mechanical or tissue valve is sewn in. The best option depends on your age, anatomy, other health conditions, and the judgment of a heart team.

How long is recovery after aortic valve replacement?

Recovery varies with the procedure and the individual. After TAVR, many people spend only a few days in the hospital and resume light activities relatively quickly. After open-heart surgery, hospital stays are typically longer, and full recovery, including healing of the breastbone, often takes several weeks to a few months. Cardiac rehabilitation programs and gradual return to activity are commonly recommended; your care team will give you a personalized timeline.

Can I exercise if I have aortic stenosis?

In many cases, yes, but the safe level depends on how severe the stenosis is. People with mild disease and no symptoms can often stay normally active. With moderate or severe stenosis, doctors may restrict strenuous or competitive exercise because of the risk of dizziness or fainting during heavy exertion. Always ask your cardiologist for individual guidance before starting or changing an exercise routine.

When to see a doctor

If you have been told you have a heart murmur or have risk factors for valve disease, it is sensible to have your heart evaluated and to attend the follow-up your doctor recommends. If you already have a diagnosis of aortic stenosis, contact your doctor promptly if your usual symptoms worsen or new ones appear, since a change in symptoms often changes the treatment plan.

Seek urgent medical care right away if you experience any of the following red-flag warning signs:

• Chest pain or pressure that is new, severe, occurs at rest, or does not go away within a few minutes.
• Fainting or near-fainting, especially during or shortly after physical activity.
• Sudden or severe shortness of breath, breathlessness at rest, or waking up at night gasping for air.
• A rapid, irregular, or pounding heartbeat accompanied by dizziness or chest discomfort.
• Rapidly worsening swelling of the legs, ankles, or abdomen.
• Fever with chills after a dental or medical procedure if you have a valve condition or a replaced valve, since this could signal a valve infection.

These symptoms do not always mean a valve emergency, but in someone with known aortic stenosis they should never be ignored. Prompt evaluation allows doctors to determine whether the valve has reached the point where treatment is needed and to intervene before complications develop.