Heart valve disease symptoms can present as mild to severe.
It is important to remember that not all patients with severe aortic stenosis suffer obvious symptoms, however on more in-depth questioning, it is often found that the patient’s activity levels have declined over time without them realising.
It’s estimated that up to 32% of patients may be symptomatic when asked.
In the video below, Interventional Cardiologist Dr Karl Poon outlines the classic triad of symptoms severe aortic stenosis patients may present with. He also describes the signs doctors should look out for in their patients, including heart sounds, blood pressure and pulse.
Some symptoms and red flags of Aortic Stenosis may include:
Many live with the debilitating symptoms of severe aortic stenosis, impacting their quality of life, adding considerable costs to the healthcare system2.
In most elderly adults, aortic stenosis is caused by a build-up of calcium on the valve leaflets. Over time, this causes the leaflets to become stiff, reducing their ability to fully open and close.
A normal aortic valve contains three leaflets. But sometimes people are born with an aortic valve that has one, two, or four leaflets. When defects are present, the aortic valve may leak, and this can cause valve problems.
Sometimes strep throat can lead to rheumatic fever which can cause scar tissue to form within the heart. When this happens, the aortic valve may not be able to open and close as it normally should.3
Shortness of breath, chest pain, light-headedness or blackouts can be a clear indication of severe aortic stenosis. Interventional Cardiologist, Associate Professor Martin Ng, pointing out that, “one of the big challenges for us as we look after more and more elderly people, is this assumption that elderly people are inherently frail, they are not,” relating this to why this disease is being under-diagnosed.
The onset of symptoms indicates a worse prognosis and is associated with approximately 50% mortality at 2 years. The cardinal symptoms of severe aortic stenosis are all typically provoked by exertion.
The majority of patients with aortic stenosis are asymptomatic. The red flags to consider when taking a patient history should include:
Dr Martin Ng states “If an elderly patient presents with shortness of breath, hear them out and put a stethoscope on their chest and see if they have a heart murmur. That could be the first step for them to get treatment.”
Important! Ask relatives if they have noticed any changes to the patient’s physical activity levels.
Asking specific questions about functional capacity may help to identify if there has been a significant deterioration over a prolonged period.
The character of the pulse tends to be of low volume, reflecting the reduction in flow across the narrowed valve, which is most prominent in the carotid region where the pressure on the palpating finger slowly rises to maximum amplitude (slow rising pulse).
Low volume, slow rising
Systolic murmur (crescendo-decrescendo)
Patients with severe aortic stenosis often develop symptoms that can restrict activities of daily living and the ability to care for themselves at home. These patients may benefit from replacement of their aortic valve, but only approximately 1 in 3 patients receive valve replacements each year.5
Patients may be asymptomatic for a prolonged period (known as a latent period) before the patient becomes symptomatic and presents with the symptoms of aortic stenosis. Once a patient exhibits symptoms of aortic stenosis, urgent treatment is required.
Interventional Cardiologist, Dr Alex Incani describes the significant quality of life impact severe aortic stenosis can have on patients as they increasingly find their daily activities unattainable. Further explaining that as the quality of life worsens, so does the condition, “the mortality at 2 years is approximately 50% and the morality at 5 years is nearly 100%.” Without treatment, symptomatic aortic stenosis will eventually lead to death.6
Without treatment survival rates in patients with severe aortic stenosis are as low as 50% at two years.