7 Key Aortic Stenosis Symptoms You Shouldn’t Ignore

Aortic valve stenosis, commonly known as aortic stenosis, is a serious heart condition that occurs when the aortic valve narrows, restricting blood flow from the heart to the rest of the body. This progressive condition forces the heart to work harder to pump blood through the narrowed valve opening, potentially leading to various cardiovascular complications.

Understanding the symptoms of aortic stenosis is crucial for early detection and proper management. Many people with mild aortic stenosis may not experience any symptoms initially, but as the condition progresses to moderate or severe aortic stenosis, warning signs become more apparent. Recognizing these symptoms early can help prevent serious complications and improve quality of life.

In this comprehensive guide, we’ll explore the most common symptoms of aortic valve stenosis, helping you understand what to watch for and when to seek medical attention.

1. Chest Pain or Angina

Chest pain, medically known as angina, is one of the most significant symptoms of aortic stenosis. This occurs because the narrowed valve forces your heart to work much harder to pump blood throughout your body, increasing the heart muscle’s oxygen demand.

The chest pain associated with aortic stenosis typically presents as:

• A squeezing, pressure, or tightness in the chest
• Discomfort that may radiate to the arms, neck, jaw, or back
• Pain that worsens during physical activity or exertion
• Discomfort that may improve with rest

This symptom occurs because the thickened heart muscle requires more oxygen than the coronary arteries can supply, especially when the valve opening becomes severely narrowed. If you experience chest pain, especially during physical activity, it’s essential to seek immediate medical evaluation as this can indicate advanced aortic stenosis.

2. Shortness of Breath (Dyspnea)

Shortness of breath, or dyspnea, is one of the most common and noticeable symptoms of aortic valve stenosis. As the condition progresses, the heart struggles to pump adequate amounts of blood through the narrowed valve, leading to fluid backup in the lungs.

Patients with aortic stenosis may experience breathlessness in several ways:

• Exertional dyspnea: Difficulty breathing during physical activities like climbing stairs, walking, or exercising
• Orthopnea: Shortness of breath when lying flat, often requiring multiple pillows to sleep comfortably
• Paroxysmal nocturnal dyspnea: Sudden breathlessness that wakes you from sleep
• Dyspnea at rest: In severe cases, breathing difficulties occur even during minimal activity or rest

The progression from breathlessness only during strenuous activity to difficulty breathing during routine tasks or at rest often indicates worsening valve stenosis and requires prompt medical attention.

3. Fatigue and Weakness

Persistent fatigue and general weakness are common but often overlooked symptoms of aortic stenosis. When the heart cannot pump sufficient blood through the narrowed valve, your body’s tissues and organs don’t receive adequate oxygen and nutrients, resulting in chronic tiredness.

This fatigue manifests as:

• Feeling exhausted even after adequate rest or sleep
• Inability to complete routine daily activities without feeling worn out
• Reduced exercise tolerance and stamina
• General weakness in the muscles, particularly during physical exertion
• Feeling mentally foggy or having difficulty concentrating

Many patients initially attribute this fatigue to aging, stress, or other conditions, which can delay diagnosis. However, if you experience persistent tiredness along with other symptoms, it’s important to discuss this with your healthcare provider, as it may indicate your heart isn’t pumping effectively due to valve stenosis.

4. Heart Palpitations or Irregular Heartbeat

Heart palpitations—the sensation of your heart racing, fluttering, or beating irregularly—are frequently reported by individuals with aortic valve stenosis. The extra workload placed on the heart due to the narrowed valve can trigger abnormal heart rhythms or arrhythmias.

Palpitations in aortic stenosis patients may feel like:

• A racing or pounding heartbeat that you can feel in your chest, throat, or neck
• Skipped beats or a fluttering sensation
• An irregular or uneven heart rhythm
• A sensation that your heart is working too hard or beating forcefully

While occasional palpitations can be harmless, frequent or persistent irregular heartbeats in the context of aortic stenosis can indicate serious complications, including atrial fibrillation or ventricular arrhythmias. These rhythm disturbances can further compromise the heart’s ability to pump blood effectively and may increase the risk of stroke or sudden cardiac events.

5. Dizziness and Fainting (Syncope)

Dizziness, lightheadedness, and fainting episodes (syncope) are particularly concerning symptoms of aortic stenosis, often indicating severe valve narrowing. These symptoms occur when the brain doesn’t receive adequate blood flow due to the heart’s inability to pump sufficient blood through the stenotic valve.

These symptoms typically present as:

• Presyncope: Feeling lightheaded or dizzy, especially when standing up quickly or during physical exertion
• Syncope: Brief loss of consciousness or fainting, particularly during exercise or exertion
• Near-fainting spells: Episodes where you feel you might pass out but don’t completely lose consciousness
• Balance problems: Unsteadiness or feeling like the room is spinning

Fainting episodes in patients with aortic stenosis are especially significant because they indicate that the heart cannot increase blood flow adequately when demands increase. This symptom warrants immediate medical evaluation, as it suggests severe aortic stenosis and carries an increased risk of sudden cardiac death if left untreated.

6. Swollen Ankles and Feet (Edema)

Swelling in the lower extremities, medically termed peripheral edema, can develop as aortic valve stenosis progresses and the heart’s pumping efficiency declines. When the heart cannot pump blood effectively forward, fluid can back up in the veins, causing swelling in the ankles, feet, and legs.

Edema associated with aortic stenosis may present as:

• Visible swelling in the ankles, feet, or lower legs, particularly noticeable at the end of the day
• Pitting edema, where pressing on the swollen area leaves an indentation
• Tight-feeling shoes or socks leaving marks on the skin
• Swelling that worsens with prolonged standing or sitting
• In advanced cases, swelling may extend up the legs and into the abdomen

While ankle swelling can result from many conditions, when it occurs alongside other aortic stenosis symptoms, it may indicate that the heart is beginning to fail and can no longer maintain adequate circulation. This development suggests progression to heart failure and requires comprehensive medical evaluation.

7. Heart Murmur

While not a symptom that patients can detect themselves, a heart murmur is often the first sign that leads to a diagnosis of aortic stenosis. A heart murmur is an abnormal sound that doctors hear through a stethoscope when blood flows turbulently through the narrowed aortic valve.

Key characteristics of aortic stenosis murmurs include:

• A harsh, crescendo-decrescendo (diamond-shaped) systolic murmur
• Best heard at the upper right sternal border
• May radiate to the neck and carotid arteries
• Often detected during routine physical examinations before symptoms appear
• Typically becomes louder as the stenosis worsens, though in very severe cases with heart failure, the murmur may become softer

If your doctor detects a heart murmur during an examination, they will likely recommend further testing such as an echocardiogram to evaluate your aortic valve structure and function. Regular monitoring is essential because aortic stenosis can progress from mild to severe over time, even in patients who initially have no symptoms.

Main Causes of Aortic Valve Stenosis

Understanding what causes aortic stenosis can help with prevention and early detection. The main causes include:

Age-Related Calcific Aortic Stenosis

The most common cause in older adults, this occurs when calcium deposits accumulate on the aortic valve leaflets over time, causing them to stiffen and narrow. This typically affects people over 65 years of age and is associated with the same risk factors as atherosclerosis, including high cholesterol, high blood pressure, diabetes, and smoking.

Congenital Bicuspid Aortic Valve

Some people are born with an aortic valve that has only two leaflets (bicuspid) instead of the normal three (tricuspid). This structural abnormality causes abnormal blood flow and increased stress on the valve, leading to earlier deterioration and stenosis, often manifesting in middle age.

Rheumatic Heart Disease

Though less common in developed countries, rheumatic fever—a complication of untreated strep throat—can damage heart valves, including the aortic valve. This typically causes scarring and fusion of the valve leaflets, leading to stenosis later in life.

Other Contributing Factors

• Chronic kidney disease: Can accelerate calcium deposits on heart valves
• Radiation therapy: Chest radiation for cancer treatment can damage heart valves over time
• Elevated cholesterol levels: Particularly elevated LDL cholesterol and lipoprotein(a)
• Metabolic syndrome: Combination of high blood pressure, abnormal cholesterol, and diabetes

Prevention Strategies

While not all cases of aortic stenosis can be prevented, especially those due to congenital abnormalities, several strategies may help reduce your risk or slow the progression of valve disease:

Maintain Heart-Healthy Lifestyle Habits

• Control blood pressure: Keep your blood pressure within recommended ranges through diet, exercise, and medication if prescribed
• Manage cholesterol levels: Follow a heart-healthy diet low in saturated fats and work with your doctor to maintain healthy cholesterol levels
• Quit smoking: Smoking accelerates cardiovascular disease and valve deterioration
• Control diabetes: If you have diabetes, maintain good blood sugar control
• Maintain healthy weight: Obesity increases cardiovascular risk factors

Practice Good Dental Hygiene

Maintaining good oral health and treating dental infections promptly can help prevent endocarditis (infection of the heart valves), which can damage the aortic valve. Brush and floss regularly, and visit your dentist for routine check-ups.

Treat Strep Infections Promptly

To prevent rheumatic fever and subsequent rheumatic heart disease, always seek medical attention for strep throat and complete the full course of prescribed antibiotics.

Regular Medical Check-ups

If you have risk factors for aortic stenosis (such as a bicuspid aortic valve, family history, or previous rheumatic fever), regular medical examinations can help detect valve problems early. Early detection allows for closer monitoring and timely intervention if needed.

Follow Medical Recommendations

If you’re diagnosed with mild aortic stenosis, following your doctor’s recommendations for monitoring and lifestyle modifications can help slow disease progression and prepare for intervention when necessary.

Frequently Asked Questions

What is the difference between aortic stenosis and aortic valve stenosis?

There is no difference—these terms are used interchangeably. Both refer to the narrowing of the aortic valve, which restricts blood flow from the left ventricle to the aorta. The condition may also be called aortic valve disease or calcific aortic stenosis when calcium deposits are the cause.

Can aortic stenosis symptoms come and go?

While aortic stenosis itself is a progressive condition that doesn’t improve on its own, symptoms may fluctuate, especially in early stages. Some people may feel fine on some days and experience symptoms on others, particularly related to activity levels. However, once symptoms develop, they typically worsen over time as the valve narrowing progresses. Consistent or worsening symptoms require medical evaluation.

How quickly does aortic stenosis progress?

The progression rate varies significantly among individuals. Mild aortic stenosis may remain stable for years or progress slowly, while others may experience more rapid deterioration. On average, the valve area decreases by about 0.1-0.3 cm² per year, and the pressure gradient across the valve increases by 10-15 mmHg annually. However, once symptoms develop in severe aortic stenosis, the prognosis worsens significantly without intervention, making regular monitoring essential.

Is aortic stenosis life-threatening?

Severe aortic stenosis can be life-threatening, particularly once symptoms develop. Without treatment, patients with symptomatic severe aortic stenosis have a poor prognosis, with survival rates dropping significantly. The classic symptoms—chest pain, shortness of breath, and fainting—indicate advanced disease. However, with proper diagnosis, monitoring, and timely intervention, outcomes can be excellent.

At what age do aortic stenosis symptoms typically appear?

The age of symptom onset depends on the underlying cause. People with congenital bicuspid aortic valves may develop symptoms in their 40s or 50s, while those with age-related calcific aortic stenosis typically experience symptoms after age 65. Rheumatic aortic stenosis symptoms usually appear decades after the initial rheumatic fever episode. However, individual variation exists, and some people may remain asymptomatic despite severe stenosis.

Can exercise make aortic stenosis worse?

Moderate exercise is generally safe and beneficial for people with mild aortic stenosis. However, strenuous or competitive exercise should be avoided in moderate to severe cases, as it can trigger dangerous symptoms like fainting or cardiac events. If you have aortic stenosis, consult your healthcare provider about appropriate exercise levels. They can perform stress tests to determine safe activity limits and provide personalized recommendations based on your condition’s severity.

Should I see a doctor if I only have mild symptoms?

Yes, even mild symptoms warrant medical evaluation, especially if you have risk factors for aortic stenosis or other heart conditions. Early diagnosis allows for proper monitoring and planning. Many people dismiss early symptoms as normal aging or being “out of shape,” but these could indicate significant valve disease. Your doctor can perform a physical examination, listen for heart murmurs, and order appropriate tests like echocardiography to assess valve function.

Can aortic stenosis be detected before symptoms appear?

Yes, aortic stenosis is often detected during routine physical examinations when a doctor hears a characteristic heart murmur through a stethoscope. This may occur years before symptoms develop. If a murmur is detected, your doctor will likely order an echocardiogram to evaluate the valve structure and measure the severity of stenosis. Regular check-ups are important, especially if you have risk factors like a bicuspid aortic valve or family history of valve disease.

References:

• Mayo Clinic – Aortic Stenosis
• American Heart Association – Aortic Valve Stenosis
• National Heart, Lung, and Blood Institute – Heart Valve Disease
• Johns Hopkins Medicine – Aortic Stenosis
• Cleveland Clinic – Aortic Stenosis