Aortic valve disease affects the important gateway between your heart and the rest of your body, potentially disrupting the flow of oxygen-rich blood that keeps you alive and healthy.

Understanding Aortic Valve Disease

The aortic valve acts like a carefully designed door in your heart. It sits between the lower left chamber of your heart, called the left ventricle, and a large blood vessel known as the aorta. The aorta is your body’s main artery, responsible for carrying oxygen-rich blood from your heart to every tissue and organ throughout your body. A healthy aortic valve opens and closes with each heartbeat, ensuring blood moves in only one direction—forward from your heart into circulation.^[1]

When the aortic valve doesn’t work properly, it creates a condition called aortic valve disease. This umbrella term covers any situation where the valve fails to open fully, close tightly, or both. The normal aortic valve has three flaps of tissue, called leaflets or cusps, that open and shut to control blood flow. When these leaflets become damaged, stiff, or misshapen, they can no longer do their job effectively.^[1]

There are two main types of aortic valve disease. The first is aortic valve stenosis, which happens when the valve opening becomes narrowed or blocked. Imagine trying to water your garden through a hose that has been pinched—less water gets through. Similarly, when the aortic valve is stenotic, less blood can flow from your heart to your body. The heart must work much harder to push blood through this narrowed opening, putting tremendous strain on the heart muscle.^[1]

The second type is aortic valve regurgitation, also called aortic insufficiency or a “leaky valve.” In this condition, the valve doesn’t close properly, allowing blood to leak backward into the heart after each beat. Instead of all the blood moving forward to nourish your body, some flows in the wrong direction. To make up for this backward leakage, your heart must pump harder to deliver enough blood to meet your body’s needs.^[1]

Some people have what’s called mixed aortic valve disease, where the valve is both narrowed and leaky at the same time. This combination creates even more challenges for the heart.^[2]

How Common Is This Condition?

Aortic valve disease is the most common form of heart valve disease in developed nations like the United States. It affects about three percent of people older than sixty-five years. The condition becomes increasingly common with advancing age, particularly in those over age sixty.^[2][13]

Among valve conditions, aortic valve disease is also the most dangerous, causing more deaths than any other type of valve disease in the United States. Many people don’t realize they have aortic valve disease until it causes symptoms or shows up during a screening test. This hidden nature of the condition in its early stages makes awareness and regular checkups especially important.^[2]

The condition affects both men and women, though being male is considered a risk factor for developing aortic valve stenosis. Some forms of aortic valve disease run in families, particularly those present from birth. About one to two percent of babies are born with a bicuspid aortic valve, meaning their valve has only two cusps instead of the normal three. While this congenital difference may not cause problems immediately, it often leads to valve disease later in life.^[4][10]

What Causes Aortic Valve Disease?

The most common cause of aortic valve disease is simply wear and tear from aging. Your aortic valve opens and closes billions of times over your lifetime—with every single heartbeat. Over many years, this constant work takes its toll. As you get older, calcium can build up on the valve leaflets, making them thick, stiff, and unable to open and close properly. This process is called calcific aortic valve disease or aortic valve calcification.^[2]

The buildup of calcium on the valve is not like the calcium that strengthens your bones. Instead, it’s similar to the process that causes hardening of the arteries, involving inflammation and deposits that stiffen the delicate valve tissue. This calcification typically develops over many years, which is why aortic stenosis from aging usually appears in people over sixty-five.^[3]

Some people are born with valve problems. A bicuspid aortic valve is the most common congenital heart defect affecting the aortic valve. Because these two-leaflet valves don’t function as smoothly as normal three-leaflet valves, they tend to develop stenosis or regurgitation earlier in life, often appearing in middle age rather than old age. Other congenital valve defects can also cause problems.^[4]

Infections can damage the aortic valve. Rheumatic fever, which results from untreated strep throat or scarlet fever, can cause lasting damage to heart valves. While rheumatic heart disease is rare in developed countries today due to widespread antibiotic treatment, it remains a problem in developing nations. The damage from rheumatic fever may take years or decades to become apparent.^[2]

Endocarditis, an infection of the heart’s inner lining and valves, can damage the aortic valve. When bacteria from an infection elsewhere in your body enter your bloodstream and settle on your heart valves, your immune system’s response to fight the infection can harm the valve tissue itself.^[2]

Several other conditions can lead to aortic valve disease. High blood pressure puts extra strain on the valve over time. An aortic dissection—a tear in the inner lining of the aorta wall—can affect how the valve functions. Chest trauma from accidents can damage the valve. Radiation therapy to the chest for cancer treatment, such as for Hodgkin lymphoma, may cause valve problems years later.^[2][4]

Certain underlying medical conditions increase the risk of valve disease. These include connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome, which affect how the body builds structural tissues. Autoimmune conditions such as lupus, rheumatoid arthritis, and ankylosing spondylitis can also contribute to valve problems. In rare cases, kidney failure and other disorders of calcium metabolism can cause aortic stenosis to develop earlier than usual.^[2][4]

Who Is at Higher Risk?

Several factors increase your chances of developing aortic valve disease. Age is the biggest risk factor—the older you get, the more likely you are to develop calcification and wear on your valve. People over age sixty face significantly higher risk, and the condition becomes even more common after age sixty-five.^[2]

If you were born with a bicuspid aortic valve, you face much higher risk of developing valve disease during your lifetime. This congenital condition often doesn’t cause symptoms in childhood, but the abnormal structure means the valve experiences more stress with each heartbeat, leading to earlier deterioration.^[2]

Having signs of calcium buildup on your valve, even if it’s not yet causing problems, puts you at increased risk of progression to more serious disease. Your doctor might detect this during an imaging test.^[2]

A history of rheumatic fever significantly increases your risk, as the damage to valve tissue from this condition can lead to problems many years later. People who have had radiation therapy to their chest, particularly for lymphoma or breast cancer, face elevated risk of developing valve disease as a late complication of their cancer treatment.^[2]

Certain inherited conditions put you at higher risk. If you have Marfan syndrome, Ehlers-Danlos syndrome, or other connective tissue disorders, your valve tissue may be more prone to problems. Having an autoimmune disease like lupus also increases your risk.^[2]

Recognizing the Symptoms

One of the challenging aspects of aortic valve disease is that many people have no symptoms in the early stages. The condition can progress silently for years. During this time, your heart compensates for the valve problem by growing thicker and stronger. This compensation, called left ventricular hypertrophy, helps maintain normal blood flow despite the valve problem. However, eventually these adaptations become insufficient, and symptoms begin to appear.^[2][3]

When symptoms do develop, they often appear gradually. Fatigue is frequently one of the first signs. You might notice that you tire more easily during activities that used to be no problem. This fatigue can disrupt your normal daily activities and reduce your quality of life.^[2]

Shortness of breath is a common symptom, particularly during physical activity. You might find yourself becoming winded climbing stairs, walking uphill, or doing yard work. As the condition worsens, shortness of breath can occur even when lying down or during sleep, sometimes waking you up at night.^[2]

Chest discomfort or pain, called angina, can develop. This might feel like pressure, squeezing, tightness, or discomfort in your chest. The sensation can extend to your neck, jaw, arm, or abdomen. Chest pain occurs because your heart muscle isn’t getting enough oxygen, even though your coronary arteries might be normal. The extra work your heart does to pump blood through a narrowed valve or make up for leakage requires more oxygen than your blood can supply.^[2]

Dizziness, lightheadedness, or fainting spells can happen, especially during physical exertion. These symptoms occur because not enough oxygen-rich blood is reaching your brain. Fainting is particularly concerning and should prompt immediate medical attention.^[2]

Heart palpitations—an unpleasant awareness of your heartbeat, which might feel like fluttering, pounding, or skipping—can occur. You might notice irregular heartbeats or a racing heart.^[2]

Swelling in your feet, ankles, or lower legs can develop as your heart struggles to pump effectively. This edema happens when fluid builds up in your tissues because blood isn’t circulating efficiently.^[2]

Some people experience unexplained weight gain from fluid retention. General weakness and a sense of not feeling well can also occur. In some cases, people with valve disease may develop a fever, particularly if the valve has become infected.^[2][7]

While survival rates in people without symptoms are similar to those of healthy people the same age, survival decreases rapidly once symptoms appear. This makes recognizing and reporting symptoms to your doctor absolutely crucial.^[2][13]

Preventing Aortic Valve Disease

While you cannot prevent all forms of aortic valve disease, especially those caused by aging or congenital defects, there are steps you can take to reduce your risk and slow progression of the condition.

Maintaining good oral hygiene is more important than you might think. Research shows that people who brush their teeth twice daily for at least two minutes have a three-fold lower risk of developing heart disease. Bacteria from your mouth can enter your bloodstream and potentially settle on your heart valves, causing infection and damage. Having regular dental checkups, at least one to two visits per year, helps protect both your oral and heart health.^[15]

Preventing and promptly treating infections, particularly strep throat, is crucial. Untreated strep infections can lead to rheumatic fever, which damages heart valves. If you have a sore throat, especially if accompanied by fever, see your doctor for proper diagnosis and treatment.^[2]

Managing high blood pressure helps protect your aortic valve from excess strain. Work with your doctor to keep your blood pressure in a healthy range through lifestyle changes and medication if needed.^[2]

Adopting a heart-healthy diet provides long-term benefits. Eat a variety of fruits, vegetables, and whole grains regularly. Choose plant-based proteins like nuts and legumes, or fish and seafood, instead of large amounts of animal meats. Reduce your intake of salt, sugar, and alcohol. Avoid processed foods, especially processed meats like sausage, ham, and bacon. Stay away from saturated fats found in animal fat, coconut oil, and palm oil. Balance your energy intake with your activity level and avoid overeating.^[15]

Regular exercise strengthens your heart and improves overall cardiovascular health. Adults should aim for one hundred fifty to three hundred minutes per week of moderate to high-intensity aerobic exercise, such as brisk walking, jogging, dancing, or running. Include resistance or weight training two to three days per week. Unless your doctor advises otherwise, physical activity is safe and beneficial even if you have mild valve disease. Exercise not only improves physical fitness but also enhances mental health, helps control weight, lowers blood pressure and cholesterol, boosts sleep quality and energy, and reduces stress.^[15]

Quitting smoking is one of the most important things you can do for your heart and valve health. Smoking damages blood vessels and may accelerate valve deterioration. Chemicals in cigarette smoke can harm your heart and contribute to calcium buildup. Secondhand smoke also poses risks. If you smoke, talk to your doctor about smoking cessation programs and support.^[15][18]

Maintaining a healthy weight reduces stress on your heart. Being overweight increases your body’s need for oxygen and worsens the effects of any type of valve disease. A body mass index (BMI) between eighteen point five and twenty-four point nine is considered healthy. If you’re overweight, reducing weight can delay and occasionally even avoid the need for surgery. Weight loss also lowers the risk of other conditions like heart attacks, high blood pressure, diabetes, and some cancers.^[18]

Annual health checkups can help detect valve disease in its early stages, often before symptoms develop. If you have risk factors like a bicuspid valve or a family history of valve disease, regular monitoring is especially important.^[15]

How the Disease Affects Your Body

Understanding what happens inside your body when you have aortic valve disease helps explain why symptoms develop and why treatment is important. The disease follows a pattern of compensation followed by decompensation.

In aortic stenosis, the narrowed valve creates an obstruction to blood flow out of the heart. Imagine your heart trying to push blood through an increasingly small opening—it must generate much more pressure to force blood through. The pressure inside your left ventricle rises significantly during each heartbeat.^[3]

To cope with this increased workload, the muscle wall of your left ventricle gradually thickens, a process called hypertrophy. This thicker, stronger muscle can generate the higher pressures needed to push blood through the narrow valve. For a while, this compensation works well, and you may have no symptoms. The thickened heart muscle maintains adequate blood flow to your body.^[3][13]

However, the thickened heart muscle also becomes stiffer, making it harder for the ventricle to relax and fill with blood between beats. This is called diastolic dysfunction. Your left atrium—the chamber that fills the ventricle—must contract more forcefully to push blood into the stiff ventricle. A strong atrial contraction becomes crucial for maintaining adequate filling of the ventricle.^[13]

As stenosis worsens, eventually the compensatory mechanisms fail. The heart muscle can no longer generate enough force to maintain adequate blood flow through the narrowed valve. The pumping function of the heart declines, leading to heart failure. When this happens, your body doesn’t receive enough oxygen-rich blood, causing symptoms like fatigue, shortness of breath, and weakness.^[3]

In aortic regurgitation, blood leaks backward from the aorta into the left ventricle during the resting phase of the heartbeat. This means the ventricle must handle both the normal amount of blood coming from the lungs plus the blood that leaked back. The volume of blood in the ventricle increases, stretching the chamber and making it larger.^[3]

Initially, this larger chamber can handle the extra volume, and the heart compensates by pumping more blood with each beat to make up for the leakage. However, over time, the increased volume and workload strain the heart muscle. The muscle weakens, pumping function declines, and heart failure develops.^[3]

The reduced blood flow and increased cardiac workload can lead to other problems. The heart muscle itself may not get enough oxygen, causing chest pain similar to that from coronary artery disease, even if your coronary arteries are healthy. Abnormal heart rhythms, called arrhythmias, can develop. Blood clots may form in the heart chambers. The risk of stroke increases. In severe cases, sudden cardiac arrest can occur.^[2]