Understanding Your Valve

What Causes Aortic Stenosis?

The most common cause of aortic stenosis in older adults is age-related calcium buildup on the valve, sometimes referred to as degenerative or calcific aortic stenosis. Over many years, calcium deposits gradually accumulate on the valve's flaps, making them stiffer and less able to open fully with each heartbeat.

Some people are born with a valve structure that differs from the typical three-flap design, most often having only two flaps instead of three, a variation called a bicuspid aortic valve. This structural difference tends to place extra mechanical stress on the valve over a lifetime, which can lead to stenosis developing significantly earlier than the typical age-related pattern seen in most cases.

Less commonly, a history of rheumatic fever, an inflammatory condition that can follow untreated strep infections, can also contribute to valve narrowing over time by causing scarring of the valve tissue. Because rheumatic fever is far less common today than it once was in many parts of the world, this cause is now seen less frequently than the age-related and congenital patterns. Understanding which of these underlying causes applies to an individual case can help explain both the age at which stenosis appeared and how it's likely to behave over time.

What Are the Symptoms of Aortic Stenosis?

Early aortic stenosis often causes no symptoms at all, since a mild narrowing typically doesn't affect the heart's ability to meet the body's everyday demands. This early, symptom-free period can last for years before any noticeable changes occur.

As the narrowing becomes more significant, symptoms tend to emerge gradually rather than all at once. Shortness of breath with physical activity is often one of the earliest noticeable changes, followed by chest pain or pressure, particularly during exertion, as the heart struggles to push blood through an increasingly narrow opening. Fatigue and reduced stamina during activities that previously felt manageable often accompany these changes as well.

In more advanced cases, dizziness or fainting episodes, especially during physical activity, can occur as the heart's ability to maintain adequate blood flow becomes more compromised. Because these symptoms can develop gradually over months or years, some people attribute them to normal aging rather than recognizing them as a sign of an underlying valve issue. This is exactly why understanding this pattern matters, particularly for anyone noticing a gradual decline in exercise tolerance without an obvious explanation.

How Is Aortic Stenosis Diagnosed?

Diagnosing aortic stenosis typically begins with a physical examination, during which a healthcare provider listens to the heart with a stethoscope. A narrowed valve often produces a distinctive murmur caused by blood being forced through a smaller opening, which is frequently the first clue that prompts further evaluation.

Imaging of the heart is the primary tool used to confirm the diagnosis and measure its severity. This type of imaging allows a direct view of the valve in motion, measuring exactly how narrow the opening has become and assessing how the heart's chambers are responding to the extra workload. This measurement is what allows stenosis to be classified along a spectrum from mild to severe.

Depending on someone's symptoms, additional testing may be used to evaluate how the heart performs under physical exertion, since some effects of stenosis only become apparent when the heart is working harder than it does at rest. Because aortic stenosis can progress at different rates for different people, tracking these measurements over time through periodic follow-up testing provides much more useful information than any single assessment taken in isolation. We perform echocardiograms right here in our Florence office, so you're not waiting days for results from an outside facility.

What Happens If Aortic Stenosis Progresses Unaddressed?

Once aortic stenosis becomes severe, the heart is working significantly harder than it should with every single beat to push blood through an increasingly narrow opening. Over time, this added strain can begin to affect the heart muscle itself, sometimes causing it to thicken as it compensates for the extra workload.

If this progression continues without being recognized, it can eventually contribute to broader strain on the heart's overall pumping function, sometimes leading to symptoms similar to those seen in other forms of heart strain, including fatigue, shortness of breath, and fluid retention. Fainting episodes can also become more frequent as the heart's ability to maintain adequate blood flow during exertion becomes more limited.

Because this progression tends to happen gradually, someone might not notice how much their tolerance for activity has declined until it's pointed out or compared to how they felt months or years earlier. This gradual pattern is exactly why understanding the trajectory of aortic stenosis, through periodic monitoring, matters so much, particularly once narrowing reaches a moderate degree, since this is typically when the condition starts to warrant closer attention.

How Can I Support My Heart Health Day to Day?

Staying physically active at a level that feels comfortable, and that's appropriate for your specific stage of aortic stenosis, supports overall cardiovascular health without placing unnecessary strain on a heart that may already be working harder than usual. For many people with mild stenosis and no symptoms, this simply means continuing normal daily activity as usual.

Managing other cardiovascular risk factors, including blood pressure and cholesterol, helps support overall heart health and reduces additional strain on a heart that's already compensating for a narrowed valve. A heart-healthy diet and maintaining a healthy weight both contribute to this same overall goal.

Paying close attention to your own baseline stamina and energy level is a particularly useful habit for aortic stenosis specifically, since the condition tends to progress gradually and subtly. Noticing whether everyday activities feel more effortful than they did months earlier can provide valuable insight even between scheduled evaluations.

Staying consistent with recommended follow-up, since aortic stenosis is generally monitored through periodic reassessment rather than a single evaluation, allows any gradual changes in valve function to be tracked reliably over time, which tends to be far more useful than relying on how you feel from day to day alone.