Severe aortic stenosis is the final stage of aortic stenosis, which is the narrowing of the aortic valve. In severe aortic stenosis, symptoms can impair quality of life.

Stenosis refers to a narrowing of the heart valves that allow blood to flow through the heart in the right direction. Aortic stenosis is the most common type and describes a narrowing of the aortic valve.

The aortic valve allows blood to flow from the heart into the aorta, which is the main artery. Blood then flows from the aorta to the rest of the body.

People with aortic stenosis have restricted blood flow out of their heart, which can make their heart work harder. They may not have noticeable symptoms for several years until aortic stenosis worsens.

Severe aortic stenosis can eventually cause symptoms that affect quality of life and daily activities. It can be suddenly fatal without treatment.

However, severe aortic stenosis can be treated to prolong life and improve well-being.

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Aortic stenosis is a common heart condition where a person has a narrowed aortic valve. It can progress as the aortic valve becomes thicker and stiffer. The final stage is known as severe aortic stenosis. Sometimes it is called a failing heart valve.

The heart contains four valves that enable it to pump blood in the correct direction. The aortic valve is the final valve that oxygen-rich blood passes through before it exits the heart and travels through the rest of the body.

When the valve thickens or hardens, it narrows the path through which blood can flow. This significantly restricts blood flow from the heart, which can cause severe and noticeable symptoms. A person with severe aortic stenosis may have heart failure.

Aortic stenosis progresses through several stages, from mild to severe:

  • Mild: People with mild aortic stenosis may have no symptoms or minor symptoms they mistake for aging, like mild shortness of breath. Healthcare professionals can detect aortic stenosis using imaging scans or examinations.
  • Moderate: Although blood flow to their heart is more restricted, people may still not notice symptoms. However, they may have damage to their heart valve. They will need to monitor for any symptoms that indicate their heart valve is failing.
  • Severe: Severe AS is a serious and life threatening condition. People with severe aortic stenosis have damage to their aortic valve, several noticeable symptoms, and may have complications. They are at high risk of sudden fatal heart failure. Without treatment, severe aortic stenosis is fatal for 1 in 2 people within 2 years.

Other guidelines have different methods of staging aortic stenosis. For example, some health experts may stage aortic stenosis from stages A to D:

  • Stage A: people at risk of aortic stenosis
  • Stage B: progressive blood flow obstruction
  • Stage C: severe aortic stenosis with no symptoms
  • Stage D: aortic stenosis is causing symptoms

Symptoms of severe aortic stenosis may include:

  • chest pain or tightness
  • syncope, also called fainting
  • feeling more exhausted after activity
  • rapid or fluttering heartbeat
  • shortness of breath
  • trouble breathing
  • dizziness
  • swollen ankles or feet
  • difficulty sleeping

If a person has new or worsening aortic stenosis symptoms, it is advisable that they seek professional medical attention immediately.

Aortic stenosis mainly affects adults over 60 years old. Normal aging can cause calcium to build up in a person’s aortic valve, making it narrower. However, they may only have symptoms starting from ages 70 or 80. About 2% to 9% of people over age 75 have severe aortic stenosis.

People may also develop aortic stenosis if they are born with a bicuspid aortic valve. A person’s aortic valve normally has three parts, or cusps. A bicuspid aortic valve has two parts. About 1 in 100 people are born with a bicuspid aortic valve. When not treated, severe aortic stenosis can develop.

Other causes of aortic stenosis that may develop into severe aortic stenosis include:

  • rheumatic valve disease, where rheumatic fever damages a person’s heart valves
  • alkaptonuria, a rare genetic condition that causes chemicals to slowly build up in a person’s body
  • radiation exposure
  • metabolic diseases, such as Fabry disease, a rare genetic condition
  • ochronosis, a rare skin condition
  • systemic lupus erythematosus (SLE), an autoimmune condition that results in widespread inflammation

Healthcare professionals can often detect aortic stenosis before it becomes severe. They can help people take steps to manage their aortic stenosis and help stop it from progressing.

These steps can include medication and lifestyle strategies, such as:

  • getting regular physical activity
  • not smoking
  • eating a balanced, nutrient-dense diet
  • managing weight
  • reducing cholesterol
  • managing blood pressure

Healthcare professionals may diagnose a person’s severe aortic stenosis with several tests:

  • physical exam
  • medical history
  • imaging scans of the heart, such as:
    • echocardiograms (echo)
    • dobutamine stress echocardiogram (DSE), which is an echo of a person’s heart taken while they exercise with a medication called dobutamine in their system
    • CT angiography scans
    • MRI scans

Healthcare professionals typically treat severe aortic stenosis by replacing the aortic valve, called aortic valve replacement (AVR).

To replace a person’s aortic valve, surgeons may use:

  • Surgical aortic valve replacement (SAVR): During SAVR, surgeons perform open-heart surgery to replace a person’s heart valve. After SAVR, people spend about 1 week in a hospital before returning home.
  • Transcatheter aortic valve replacement (TAVR): Also called transcatheter aortic valve implantation (TAVI), TAVR is a noninvasive procedure where a cardiologist guides a replacement valve through a blood vessel into the heart. They implant the valve using an expanding balloon.

Healthcare professionals will discuss treatment options, risks, and benefits of heart valve replacement with a person beforehand.

After valve replacement, symptoms normally resolve. A person will have medical follow-ups throughout their life to make sure the replacement valve is working correctly.

Aortic stenosis describes the narrowing of the aortic valve. Severe aortic stenosis is the final stage of the condition. It can significantly restrict blood flow through a person’s heart and into their body.

People may have no symptoms until their aortic stenosis becomes severe. They may then have several symptoms that interfere with their quality of life and daily activities.

Severe aortic stenosis may be suddenly fatal. However, surgeons can treat it with procedures to replace a person’s heart valve. Healthcare professionals can also help people prevent their aortic stenosis from becoming severe with medication and lifestyle strategies.