7 Key Signs and Symptoms of Aortic Valve Disease You Should Know

Aortic valve disease is a serious cardiovascular condition that affects the valve between the heart’s main pumping chamber (left ventricle) and the body’s main artery (aorta). This valve plays a crucial role in maintaining proper blood flow throughout your body. When it becomes damaged or diseased, it can significantly impact your heart’s ability to function efficiently.

The aortic valve can be affected in two primary ways: it may become narrowed (aortic stenosis), preventing it from opening fully, or it may not close properly (aortic regurgitation), allowing blood to leak backward. Both conditions force your heart to work harder to pump blood, which can lead to various symptoms and complications if left untreated.

Recognizing the symptoms of aortic valve disease early is essential for timely diagnosis and management. Many people with mild aortic valve disease may not experience any symptoms initially, but as the condition progresses, certain warning signs begin to appear. Understanding these symptoms can help you seek medical attention promptly and prevent serious complications.

1. Chest Pain or Tightness (Angina)

Chest pain, also known as angina, is one of the most significant symptoms of aortic valve disease. This discomfort occurs because the heart muscle isn’t receiving enough oxygen-rich blood due to the valve’s inability to function properly.

The chest pain associated with aortic valve disease typically manifests as:

• A tight, squeezing, or pressure-like sensation in the chest
• Discomfort that may radiate to the arms, neck, jaw, or back
• Pain that often worsens with physical activity or exertion
• Symptoms that may improve with rest

This type of chest pain occurs because the narrowed or leaking valve forces your heart to work harder, increasing its oxygen demand. When the coronary arteries cannot supply enough oxygen to meet this increased demand, you experience angina. It’s important to note that chest pain can be a sign of other serious heart conditions, so any chest discomfort should be evaluated by a healthcare professional immediately.

2. Shortness of Breath (Dyspnea)

Shortness of breath, medically termed dyspnea, is another hallmark symptom of aortic valve disease. This symptom can occur during physical activity or even at rest as the condition progresses.

Patients with aortic valve disease may experience breathlessness in several ways:

• Difficulty breathing during routine activities like walking, climbing stairs, or exercising
• Feeling winded after minimal exertion
• Breathing difficulties that worsen when lying flat (orthopnea)
• Sudden shortness of breath that wakes you from sleep (paroxysmal nocturnal dyspnea)

The breathlessness occurs because the diseased valve prevents adequate blood flow from the heart to the lungs and body. This causes fluid to back up into the lungs, making it harder to breathe. As the heart struggles to compensate for the faulty valve, your respiratory system must work overtime, leading to the sensation of breathlessness. Early-stage aortic valve disease may only cause shortness of breath during strenuous activity, but as the disease advances, you may feel breathless even during rest or sleep.

3. Fatigue and Weakness

Persistent fatigue and generalized weakness are common yet often overlooked symptoms of aortic valve disease. These symptoms result from inadequate blood flow and oxygen delivery to your body’s tissues and organs.

Individuals with aortic valve disease frequently report:

• Feeling unusually tired despite adequate rest and sleep
• Lack of energy to perform daily tasks
• Muscle weakness, particularly during physical activities
• Reduced exercise tolerance and stamina
• A general sense of exhaustion that doesn’t improve with rest

When your aortic valve doesn’t function properly, your heart cannot pump blood efficiently throughout your body. This means your muscles, brain, and other organs don’t receive the oxygen and nutrients they need to function optimally. As a result, you may feel constantly tired and weak. Many people mistakenly attribute these symptoms to aging, stress, or being out of shape, which can delay diagnosis. However, if you notice persistent fatigue that interferes with your normal activities, it’s important to consult with a healthcare provider.

4. Heart Palpitations or Irregular Heartbeat

Heart palpitations—the sensation of feeling your heart beating rapidly, irregularly, or forcefully—are another common symptom of aortic valve disease. These sensations can be alarming and uncomfortable.

Palpitations associated with aortic valve disease may include:

• A fluttering sensation in the chest
• The feeling that your heart is pounding or racing
• Skipped beats or extra beats
• A strong, forceful heartbeat that you can feel in your chest or neck
• Irregular heart rhythms (arrhythmias)

The diseased valve forces your heart to work harder to maintain adequate blood flow. This extra workload can affect the heart’s electrical system, leading to abnormal heart rhythms. Additionally, when the valve leaks (regurgitation), the heart may beat more forcefully as it tries to compensate for the blood flowing backward. Some people describe feeling their heart “thumping” in their chest or neck. While occasional palpitations can be harmless, persistent or frequent palpitations warrant medical evaluation, especially when accompanied by other symptoms like dizziness or shortness of breath.

5. Dizziness and Fainting (Syncope)

Dizziness, lightheadedness, and fainting episodes are particularly concerning symptoms of aortic valve disease, especially aortic stenosis. These symptoms indicate that your brain isn’t receiving adequate blood flow.

These neurological symptoms may present as:

• Feeling lightheaded or dizzy, particularly when standing up quickly or during physical exertion
• A sensation that the room is spinning (vertigo)
• Brief loss of consciousness or fainting (syncope)
• Near-fainting episodes where you feel like you might pass out
• Difficulty maintaining balance

When the aortic valve is severely narrowed, it restricts blood flow from the heart to the rest of the body, including the brain. During physical activity, when your body demands more blood flow, the narrowed valve cannot accommodate this increased need. This results in a sudden drop in blood pressure and reduced blood flow to the brain, causing dizziness or fainting. Fainting episodes related to aortic valve disease are particularly dangerous because they can occur without warning and may lead to falls and injuries. If you experience syncope or near-syncope, seek immediate medical attention as this can indicate severe aortic valve disease.

6. Swelling in the Ankles, Feet, and Legs (Edema)

Swelling in the lower extremities, medically known as peripheral edema, is a symptom that typically appears as aortic valve disease progresses and the heart begins to fail to pump blood effectively.

This swelling typically manifests as:

• Puffiness in the ankles, feet, and lower legs
• Swelling that worsens throughout the day and may improve overnight
• Indentation that remains when you press on the swollen area (pitting edema)
• Tightness in shoes or difficulty fitting into footwear
• In more advanced cases, swelling may extend to the abdomen (ascites)

Edema occurs when the diseased aortic valve causes the heart to pump less efficiently, leading to a backup of blood in the vessels. This increased pressure forces fluid out of the blood vessels and into the surrounding tissues, particularly in the lower parts of the body where gravity has the greatest effect. The retention of fluid is also influenced by kidney function, as the reduced blood flow triggers the kidneys to retain salt and water. While ankle swelling can have many causes, including prolonged standing or certain medications, when it occurs alongside other cardiovascular symptoms, it suggests that the heart is struggling to maintain adequate circulation.

7. Heart Murmur

A heart murmur is an abnormal sound heard when a doctor listens to your heart with a stethoscope. While a heart murmur itself isn’t something you can feel, it’s often the first clinical sign that alerts healthcare providers to the possibility of aortic valve disease.

Understanding heart murmurs in aortic valve disease:

• The murmur represents turbulent blood flow through the diseased valve
• In aortic stenosis, the murmur occurs as blood struggles to flow through the narrowed valve opening
• In aortic regurgitation, the murmur is caused by blood leaking backward through the incompetent valve
• The characteristics of the murmur (timing, location, and intensity) help doctors determine the type and severity of valve disease
• Some people may be aware of unusual sounds or sensations in their chest, though many have no symptoms

Many people with aortic valve disease are first diagnosed after a healthcare provider detects a heart murmur during a routine physical examination. The murmur may be present for years before other symptoms develop. While you cannot detect a heart murmur yourself, it’s important to attend regular check-ups where your doctor can listen to your heart. If a murmur is detected, further testing such as an echocardiogram will typically be ordered to evaluate the heart valves and determine if treatment is necessary.

Main Causes of Aortic Valve Disease

Understanding what causes aortic valve disease can help with prevention and early detection. The condition can develop due to several factors:

Congenital Heart Defects

Some people are born with an abnormal aortic valve. The most common congenital defect is a bicuspid aortic valve, where the valve has two leaflets instead of the normal three. This structural abnormality makes the valve more susceptible to wear and tear over time, often leading to valve disease earlier in life.

Age-Related Degeneration

As we age, calcium deposits can build up on the aortic valve, causing it to stiffen and narrow. This process, called calcific aortic stenosis, is the most common cause of aortic valve disease in older adults, typically affecting people over 65 years old.

Rheumatic Fever

Although less common in developed countries due to antibiotic treatment of strep throat, rheumatic fever remains a significant cause of aortic valve disease worldwide. This condition, which results from untreated streptococcal infections, can damage the heart valves and lead to scarring and dysfunction.

Infective Endocarditis

This is an infection of the inner lining of the heart chambers and valves. Bacteria or other microorganisms can enter the bloodstream and attach to the heart valves, causing damage and potentially leading to valve disease. People with existing valve abnormalities are at higher risk for endocarditis.

Other Risk Factors

Additional factors that may contribute to aortic valve disease include:

• High blood pressure (hypertension)
• High cholesterol levels
• Chronic kidney disease
• History of radiation therapy to the chest
• Autoimmune conditions such as lupus
• Connective tissue disorders like Marfan syndrome

Prevention Strategies

While some causes of aortic valve disease, such as congenital defects, cannot be prevented, there are several steps you can take to reduce your risk of developing valve disease or slow its progression:

Maintain Heart-Healthy Habits

Adopting a heart-healthy lifestyle is crucial for preventing valve disease:

• Follow a balanced diet rich in fruits, vegetables, whole grains, and lean proteins
• Limit saturated fats, trans fats, sodium, and added sugars
• Maintain a healthy weight through proper nutrition and regular exercise
• Engage in at least 150 minutes of moderate-intensity aerobic activity per week
• Avoid smoking and limit alcohol consumption

Manage Cardiovascular Risk Factors

Controlling conditions that affect heart health can help protect your valves:

• Keep blood pressure within normal ranges through lifestyle modifications and medication if prescribed
• Manage cholesterol levels through diet, exercise, and medication if recommended by your doctor
• Control blood sugar levels if you have diabetes
• Treat sleep apnea if diagnosed

Prevent Infections

Protecting yourself from infections can help prevent valve damage:

• Practice good dental hygiene by brushing and flossing daily and visiting the dentist regularly
• Treat strep throat infections promptly with antibiotics to prevent rheumatic fever
• If you have a known valve problem or artificial valve, inform your dentist and doctor, as you may need antibiotics before certain dental or medical procedures

Regular Medical Check-ups

Routine healthcare visits are essential for early detection:

• Attend regular physical examinations where your doctor can listen to your heart
• If you have a heart murmur or known valve abnormality, follow your doctor’s recommendations for monitoring
• Discuss any new or worsening symptoms with your healthcare provider promptly
• If you have a family history of heart valve disease or congenital heart defects, inform your doctor

Frequently Asked Questions

Can aortic valve disease be detected early before symptoms appear?

Yes, aortic valve disease can often be detected before symptoms develop. Many cases are first identified when a doctor hears a heart murmur during a routine physical examination. If you have risk factors such as a family history of valve disease or a known bicuspid aortic valve, your doctor may recommend periodic echocardiograms to monitor the valve even in the absence of symptoms.

How quickly does aortic valve disease progress?

The progression of aortic valve disease varies significantly from person to person. Some people may have mild valve disease that remains stable for many years, while others experience more rapid progression. Factors affecting progression include the underlying cause, severity at diagnosis, age, and presence of other cardiovascular conditions. Regular monitoring with your cardiologist is essential to track any changes in valve function.

Is aortic valve disease a life-threatening condition?

Aortic valve disease can become life-threatening if left untreated, particularly when it reaches severe stages. Severe aortic stenosis or regurgitation can lead to heart failure, dangerous heart rhythm abnormalities, and sudden cardiac death. However, with proper diagnosis, monitoring, and timely intervention when necessary, many people with aortic valve disease live long, healthy lives. This is why recognizing symptoms and seeking medical attention is so important.

What is the difference between aortic stenosis and aortic regurgitation?

Aortic stenosis occurs when the aortic valve becomes narrowed or stiffened, restricting blood flow from the left ventricle to the aorta. Aortic regurgitation (also called aortic insufficiency) happens when the valve doesn’t close properly, allowing blood to leak backward into the left ventricle. Both conditions force the heart to work harder, but they do so in different ways. Some people may have both conditions simultaneously. Your doctor can determine which type you have through physical examination and imaging tests.

Can lifestyle changes reverse aortic valve disease?

Unfortunately, lifestyle changes cannot reverse structural damage to the aortic valve once it has occurred. However, maintaining a heart-healthy lifestyle is still extremely important because it can help slow disease progression, manage symptoms, reduce the risk of complications, and improve overall cardiovascular health. Lifestyle modifications are a crucial component of managing aortic valve disease alongside regular medical monitoring.

When should I see a doctor about potential aortic valve disease symptoms?

You should see a doctor if you experience any symptoms of aortic valve disease, particularly chest pain, unexplained shortness of breath, fainting episodes, or heart palpitations. Seek immediate emergency care if you have severe chest pain, sudden severe shortness of breath, or loss of consciousness. Even if symptoms are mild, it’s important to have them evaluated, as early detection and monitoring can significantly improve outcomes.

Are certain people more at risk for developing aortic valve disease?

Yes, certain factors increase the risk of developing aortic valve disease. These include being over 65 years old, having a history of rheumatic fever, having a bicuspid aortic valve or other congenital heart defect, having high blood pressure or high cholesterol, having chronic kidney disease, and having a family history of valve disease. If you have any of these risk factors, discuss screening and monitoring options with your healthcare provider.

References:

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