Aortic Stenosis - Symptoms

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What are the symptoms of aortic stenosis?

The major symptoms of aortic stenosis are:

  • chest pain (angina),
  • fainting (syncope), and
  • shortness of breath (due to heart failure).

In 4% of the patients with aortic stenosis, the first symptom is sudden death, usually during strenuous exertion.

The exact reason for sudden death is unknown. It may be due to heart rhythm abnormalities secondary to inadequate blood flow through the narrowed aortic valve into the coronary arteries of the heart. Insufficient oxygen to the inner lining of the heart muscle occurs do to the lack of blood flow to the coronary arteries, particularly during strenuous exercise. Lack of oxygen in the heart muscles causes chest pain and possibly abnormal heart rhythms.

Chest pain is the first symptom in one-third of patients and eventually occurs in one-half of patients with aortic stenosis. Chest pain in patients with aortic stenosis is the same as chest pain (angina) experienced by patients with coronary artery disease. In both of these conditions, pain is described as pressure below the breast bone brought on by exertion and relieved by rest. In patients with coronary artery disease, chest pain is due to inadequate blood supply to the heart muscles because of narrowed coronary arteries. In patients with aortic stenosis, chest pain often occurs without any underlying narrowing of the coronary arteries. The thickened heart muscle must pump against high pressure to push blood through the narrowed aortic valve. This increases heart muscle oxygen demand in excess of the supply delivered in the blood, causing chest pain (angina).

Fainting (syncope) related to aortic stenosis is usually associated with exertion or excitement. These conditions cause relaxation of the body's blood vessels (vasodilation), lowering blood pressure. In aortic stenosis, the heart is unable to increase output to compensate for the drop in blood pressure. Therefore, blood flow to the brain is decreased, causing fainting. Fainting can also occur when cardiac output is decreased by an irregular heart beat (arrhythmia). Without effective treatment, the average life expectancy is less than 3 years after the onset of chest pain or syncope symptoms.

Shortness of breath from heart failure is the most ominous sign. It reflects the heart muscle's failure to compensate for the extreme pressure load of aortic stenosis. Shortness of breath is caused by increased pressure in the blood vessels of the lung due to the increased pressure required to fill the left ventricle. Initially, shortness of breath occurs only during activity. As the disease progresses, shortness of breath occurs at rest. Patients can find it difficult to lie flat without becoming short of breath (orthopnea). Without treatment, the average life expectancy after the onset of heart failure due to aortic stenosis is between 6 to 24 months.

Return to Aortic Stenosis

See what others are saying

Comment from: Piano Girl, 65-74 Female (Patient) Published: September 10

I'm a 73 y/o female who has always been very active and energetic. I have always exercised regularly; most recently did morning TRX classes almost daily; also walked in my neighborhood afternoons. Two weeks ago I started having symptoms of lightheadedness, some dizziness, shortness of breath and fatigue; just a general sense of malaise. Have always had a murmur; but was told not to worry. A recent ECHO shows I have mild aortic stenosis. Was referred to a cardiologist and that apt is tomorrow. I look forward to seeing what my plan of care will be!

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