Aortic Stenosis : Symptoms, Diagnosis, Treatment

What is aortic stenosis?

Aortic stenosis is narrowed aortic valve opening. It is the most common valvular problem in the West and in India, the prevalence is increasing.

Aortic valve guards and directs blow flow from the left ventricle into the aorta.

Aortic stenosis restricts the blood flow from the left ventricle into the aorta leading to pressure buildup within the left ventricle.

Ageing related progressive scarring and calcium deposition leads to aortic stenosis. The aortic valve is vulnerable to damage because the blood flow to the entire body passes through it at high pressure.

Aortic stenosis is a potentially life-threatening condition when severely narrowed.

Aortic Valve Stenosis
Aortic Valve Stenosis

Who is at risk for aortic stenosis?

  • Aortic stenosis in the elderly starts at around 60 years but symptoms begin in seventh and eighth decades.
  • Aortic stenosis in the young is due to defective aortic valve structure. Instead of three leaflets, there are only two leaflets (bicuspid) leading to rapid degeneration. The disease starts after 40 years and symptoms appear in 5th to 6th
  • Congenital Aortic Stenosis presence immediately after birth and not compatible with life unless treated early. Instead of 3 cusps there is a single cusp or closed aortic valve
  • Rheumatic Aortic Stenosis: Rheumatic fever can affect the heart leading to aortic stenosis.
  • Accelerated degeneration of aortic valve leading to aortic stenosis happens in diabetes, high cholesterol, high blood pressure, chronic kidney disease, chest radiotherapy etc.

What are the complications of aortic stenosis?

How is aortic valve stenosis diagnosed?

  • Assessment of signs and symptoms
  • Evaluation of medical record
  • Physical examination
  • Echocardiogram
  • Evaluation of type of aortic valve – bicuspid or tricuspid
  • Assessment of severity of aortic stenosis
  • Estimation of heart function and blood pressure in the lungs
  • 3-D reconstruction allows exact severity as well as aortic valve structure
  • Transesophageal echocardiogram (TEE) – Evaluate the aortic valve in better detail

Other tests include  

  • Electrocardiogram (ECG)
  • Chest X-Ray
  • Cardiac CT scan
  • Cardiac Catheterization – Performed when additional information is required especially to look for blocks in blood vessels supplying heart by performing a test called coronary angiography. It also provides accurate information on heart function and pressure in various chambers of the heart.

What treatment options are available for aortic stenosis?

  • When aortic stenosis is of mild or moderate severity narrowed we can closely monitor the progression with a good echo and clinical evaluation. The key is having a good echo and if not done well, severe aortic stenosis can be missed or underestimated.
  • Severe aortic stenosis has to be treated by valve replacement. Unlike the past aortic valve replacement is not limited to symptomatic disease but instead to severe stenosis also.

What happens if Aortic Stenosis is not treated?

  • Aortic Stenosis is a disease of high sudden mortality. It is important to treat patients when they develop severe stenosis or if they become symptomatic or heart functions worsens. Once with the onset of symptoms, the patient has a high risk of sudden death.

How is aortic valve stenosis treated?

  • No pill can cure or improve stenosis. Certain medications assist to control symptoms and lower the prospect of developing complications. They include ACE inhibitors, which may open blood vessels more fully.
  • Medicines that tame cardiac rhythm problems
  • Beta-blockers, which slows the heartbeat
  • Diuretics (“water pills”), which lessen the quantity of fluid in the body and the as stressing the on the heart.

Valve Replacement is the definitive procedure for treating Aortic Stenosis:

  • Transcatheter aortic valve replacement (TAVR) was initially used only in patients with severe symptomatic aortic stenosis and prohibitive risk for surgical aortic valve replacement (SAVR). Nowadays it is used to treat intermediate as well as low-risk cases for surgery.
  • Balloon valvuloplasty aims to repair the heart’s faulty valve. A flexible, thin tube tipped with a deflated balloon is passed through a cut in the groin into an artery and up to the heart. Once across the aortic valve, the balloon is inflated to open up the narrowed valve. Then the balloon is deflated and pulled out. This procedure provides temporary relief and needs to be combined with valve replacement, either surgical or transcatheter.
  • Surgical Aortic Valve Replacement is the replacement of the aortic valve with an artificial valve. This procedure involves surgery and opening of the chest. In the past it used to be the only way for replacement of aortic valve and surgery could not be taken up in many deserving cases because of co-morbidities such as renal failure, previous bypass surgery, carotid stenosis, heart failure, associated blocks in heart vessels etc. For all these patients, TAVR is an excellent option.

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