Aortic Stenosis — Symptoms, Stages and Treatment in Hyderabad
Aortic stenosis is the most common valve disease in adults over 65 — and one of the most treatable once symptoms appear. The aortic valve narrows progressively over years, forcing the heart to work harder with each beat until eventually it can no longer compensate. The arrival of symptoms marks a critical turning point — without treatment, median survival after symptom onset is 2 to 3 years.
What is aortic stenosis?
The aortic valve sits at the outlet of the heart's main pumping chamber — the left ventricle. It opens with each heartbeat to allow oxygenated blood to flow into the aorta and out to the body, then closes to prevent backflow. In a normal adult the valve has three thin, pliable leaflets with a total opening area of 3 to 4 cm².
In aortic stenosis, calcium deposits accumulate on the valve leaflets over years — the same calcification process that occurs in arteries. The leaflets become thick, rigid, and unable to open fully. As the valve opening progressively narrows, the pressure gradient across it increases — the heart must generate ever-higher pressures to push blood through. Over time the heart muscle thickens and stiffens from this increased workload, eventually weakening.
| Mild AS | Valve area above 1.5 cm². Small gradient. Usually no symptoms. Echo surveillance annually. |
| Moderate AS | Valve area 1.0–1.5 cm². Increasing gradient. May begin to notice reduced exercise tolerance. Echo every 1–2 years. |
| Severe AS | Valve area below 1.0 cm². Peak velocity above 4 m/s. Mean gradient above 40 mmHg. Treatment indicated once symptoms appear — or in selected asymptomatic patients with very high gradients or reduced EF. |
| Very severe AS | Valve area below 0.6 cm². Peak velocity above 5 m/s. Urgent treatment even if symptoms are not yet prominent. |
The classic symptom triad — act immediately when these appear
Chest pain (angina) on exertion. Breathlessness — initially on exertion, progressing to rest. Syncope (blackouts) — particularly with exertion. Once any of these three symptoms appear, median survival without valve replacement is 2 to 3 years. Treatment should not be delayed.
Causes of aortic stenosis
- Calcific (degenerative) aortic stenosis — the most common cause in adults over 65. The same risk factors that cause coronary artery disease — hypertension, high cholesterol, smoking, and diabetes — accelerate valve calcification. Currently no medication prevents or slows this process.
- Bicuspid aortic valve — a congenital condition where the valve has two leaflets instead of three, affecting 1–2% of the population. Bicuspid valves calcify and stenose 10 to 20 years earlier than tricuspid valves — meaning aortic stenosis in patients aged 40 to 60 is often bicuspid in origin.
- Rheumatic heart disease — damage from rheumatic fever (streptococcal infection) causing valve leaflet thickening, fusion, and scarring. More common in South Asia than Western populations due to historically higher rates of rheumatic fever.