Aortic Valve Stenosis Symptoms: Shortness of Breath and Fainting

Aortic valve stenosis is a disease that can progress for many years without any symptoms, yet becomes serious rapidly once symptoms begin. In this article I will explain the symptoms of aortic stenosis and why it follows such an insidious course.

Why Is Aortic Stenosis So Insidious?

The heart expends more and more force to pump blood against the narrowed aortic valve, and the heart muscle adapts to this load by thickening (hypertrophy); thanks to this adaptive mechanism, our patients may feel no symptoms at all for years. However, beyond a certain point this compensatory mechanism becomes insufficient and symptoms appear relatively quickly.

Exertional Shortness of Breath and Chest Pain

The most common first symptoms are shortness of breath on exertion, chest pain (angina) and dizziness or a feeling of fainting (syncope); these symptoms arise because the heart cannot push enough blood through the narrowed valve and cannot meet the body’s increased oxygen demand during exertion. Some of our patients attribute these symptoms to “getting older” or “being out of shape” and ignore them for a long time.

What Happens If Aortic Stenosis Is Left Untreated? (Risk of Sudden Death)

Classic studies of the natural course of aortic stenosis have shown that once symptoms begin, average life expectancy in untreated severe aortic stenosis shortens strikingly; on average a few years after chest pain begins, even shorter after a fainting episode, and once heart failure develops serious outcomes may be seen within one to two years on average. For this reason the onset of symptoms is the single most important trigger for the decision to replace the valve (surgery or TAVI).

Frequently Asked Questions

Is surgery necessary in asymptomatic aortic stenosis? Usually no; in asymptomatic patients close follow-up with regular echocardiography is sufficient, and the decision to operate is made when symptoms begin or when valve function deteriorates significantly.

Should a feeling of fainting during exertion be taken seriously? Absolutely yes; this is one of the most serious symptoms of aortic stenosis and must be evaluated without delay.

How soon after symptoms begin should I be treated? Treatment after symptom onset is usually planned within weeks; delay may carry serious risks.

Conclusion

Aortic valve stenosis progresses silently, but once symptoms begin it is a serious disease that must be evaluated without delay. Shortness of breath, chest pain or a feeling of fainting on exertion always requires cardiological assessment.

If you experience exertion-related shortness of breath, chest pain or a feeling of fainting, you can book an appointment for a detailed echocardiographic assessment.

References

1. Ross J Jr, Braunwald E. Aortic Stenosis. Circulation. 1968;38(1 Suppl):61-67.
2. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.