Aortic stenosis risk factors: who is more likely

What aortic stenosis is

Stenosis happens when the flaps of a heart valve become thick, stiff or stuck together, so the valve cannot open all the way and not enough blood can pass through. Aortic valve stenosis is a common type of stenosis. It affects the valve that controls blood flow into the large artery that carries blood out of the heart to the body (MedlinePlus).

The aortic valve lies between the left ventricle and the aorta. When a valve is too narrow, the heart has to work harder to pump enough blood to the body (NHLBI). Heart valve problems can be present at birth or develop over time, with age or because of an infection (NHLBI).

Risk factors for aortic stenosis and other valve diseases

NHLBI and MedlinePlus list risk factors for heart valve diseases as a group. These are the ones they name; a few apply to aortic stenosis in particular.

• Older age. With age, the heart valves can become thick and stiff (MedlinePlus). NHLBI says older age can be a risk factor, especially if your lifestyle habits also raise your risk (NHLBI).
• Being male. At all ages, men are more likely than women to have certain heart valve conditions, such as aortic stenosis (NHLBI).
• A bicuspid aortic valve. This is an aortic valve that forms with two flaps instead of three, which can lead to stenosis (NHLBI). It is a type of inherited heart valve disease, and bicuspid aortic valve problems can run in families (NHLBI). MedlinePlus notes that a valve that was not formed right sometimes causes problems right away, and other times may work well enough for years before causing problems (MedlinePlus).
• Rheumatic fever. An untreated strep throat can become rheumatic fever, which can harm the heart valves. The damage may not show up for years (MedlinePlus).
• Other heart and blood vessel conditions: endocarditis, a heart attack, heart failure, and coronary artery disease, especially when it affects the aorta (MedlinePlus).
• Other conditions: high blood pressure, high blood cholesterol, diabetes, and obesity and overweight (MedlinePlus). NHLBI adds autoimmune disorders such as lupus (NHLBI).
• Lifestyle habits: risk factors for other types of heart disease may put you at risk for heart valve diseases too, including a lack of physical activity, unhealthy eating patterns, smoking and obesity (NHLBI).
• Family history of early heart disease: MedlinePlus defines this as a father or brother who had heart disease younger than 55, or a mother or sister who had heart disease younger than 65 (MedlinePlus). NHLBI says a family history of early coronary heart disease can raise your risk (NHLBI).
• Radiation treatment for cancer can cause thickening and narrowing of heart valves (NHLBI).
• Medical devices: defibrillators and pacemakers can rub against a valve and create scar tissue, or stimulate the heart to beat out of rhythm, which can stretch a heart valve (NHLBI).

Valve disease can also be present at birth. Congenital heart valve diseases develop before a baby is born because of problems in the way the heart forms, and the most common of these is a valve that is too narrow (stenosis) (NHLBI).

Symptoms

Symptoms of heart valve diseases that occur with older age may happen slowly, and you may have no symptoms at all. When they occur, NHLBI lists (NHLBI):

• breathing problems, especially when climbing stairs, moving fast or otherwise exerting yourself;
• chest pain or discomfort, also called angina;
• dizziness, fainting when standing up, or a short-term loss of consciousness;
• feeling more tired than usual;
• fever, which may signal an infection that can lead to endocarditis;
• feeling like your heart is beating too fast or skipping a beat;
• a heart murmur, an unusual sound heard between heartbeats;
• swelling around the eyes, ankles or abdomen.

In babies, NHLBI says to call 9-1-1 right away if a child has a blue skin tone, a weak pulse or signs of shock, and to call your doctor if your child has problems eating (NHLBI).

Without treatment, the extra workload on the heart can lead to heart failure, stroke, blood clots, and sudden cardiac arrest or death (MedlinePlus).

Diagnosis and treatment

A provider may hear an abnormal sound, such as a click or a heart murmur, and will usually refer you to a cardiologist; you will likely need one or more heart tests (MedlinePlus).

Heart valve disease is a lifelong condition. It may stay the same throughout your life, or slowly get worse until you notice symptoms. Your provider may recommend heart-healthy lifestyle changes or medicines first, and you may eventually need the valve repaired or replaced (NHLBI). Transcatheter aortic valve replacement (TAVR), sometimes called TAVI, replaces the aortic valve to treat aortic stenosis using a catheter rather than open-heart surgery (NHLBI). MedlinePlus notes you may need surgery even if you don't have symptoms, and that biologic replacement valves tend to wear out after 10 to 15 years while mechanical valves usually mean taking blood thinners for life (MedlinePlus).

Lowering the chance of valve disease

Not every cause is preventable. NHLBI lists steps that can lower your risk of acquired heart valve diseases (NHLBI):

• make heart-healthy lifestyle changes: a heart-healthy diet, physical activity, aiming for a healthy weight, quitting smoking (see our quit smoking help check) and managing stress;
• practice good skin and dental hygiene, which can help protect you from infections that cause endocarditis;
• take medicines as prescribed to prevent a heart attack, high blood pressure or heart failure;
• if you have strep throat, finish all of your prescribed medicine to help prevent rheumatic fever.

For congenital valve disease, NHLBI suggests talking to your doctor about vitamins you may need and how to avoid infections such as rubella during pregnancy (NHLBI).

Common questions

Is aortic stenosis just part of getting older?

Older age is a risk factor, because with age the heart valves can become thick and stiff (MedlinePlus). But NHLBI warns that early signs, such as getting breathless during typical activities, are often mistaken for normal aging, and an echocardiogram can check for a valve problem (NHLBI).

Is aortic stenosis inherited?

A bicuspid aortic valve, which can cause stenosis, is a type of inherited heart valve disease and can run in families (NHLBI).

Can you have aortic stenosis without symptoms?

Yes. NHLBI says you may have a heart valve problem but not experience any symptoms, or symptoms may develop over time; extreme tiredness is often the first symptom (NHLBI).