Aortic stenosis: recognizing symptoms beyond shortness of breath

Typical symptoms and why they can go unnoticed

Aortic stenosis gradually reduces the blood flow pumped by the left ventricle. The heart initially compensates for this obstruction, which explains the long silent phase of the disease. When the valve is sufficiently narrowed and the heart can no longer maintain an adequate flow during exertion, three symptoms appear.

• Exertional dyspnea : shortness of breath occurring during physical activity, sometimes during modest efforts like climbing stairs or walking at a brisk pace. It is often progressive, developing over several months, and can be attributed to age or physical deconditioning. ‍
• Exertional angina : pain or tightness in the chest triggered by exertion. It can resemble pain of coronary origin, especially since both conditions can coexist in the same patient. ‍
• Exertional syncope : a dizzy spell or loss of consciousness occurring during or just after physical exertion. This symptom, even if brief, is a warning sign that should be reported to your cardiologist without delay.

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When disease progresses silently: asymptomatic stenosis

Severe aortic stenosis can be identified via echocardiography even when the patient feels no clear symptoms. This asymptomatic phase can last for several years.

The French Society of Cardiology describes a well-documented phenomenon: some patients gradually reduce their activity levels to avoid exertion without even realizing it. They describe themselves as asymptomatic, when in fact they have simply adapted to their limitations. This profile, referred to by the SFC as "de facto asymptomatic," can delay the detection of early warning signs.

In asymptomatic cases, an exercise stress test may be prescribed to objectively assess exercise tolerance and detect potential clinical or electrical signs that are masked at rest. The decision to proceed rests with the medical team, based on each patient's individual profile.

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Situations that warrant a prompt discussion with your cardiologist

For patients being monitored for aortic stenosis, certain signs justify contacting your cardiologist without waiting for your next scheduled appointment:

• Shortness of breath that has appeared or clearly worsened during exertion since your last consultation
• Chest pain or tightness triggered by physical activity
• Fainting or loss of consciousness, even if brief, occurring during exertion
• Any new symptom that the patient did not have during their last check-up

These situations require evaluation by the medical team, who will determine the appropriate course of action based on the stage of the disease and the overall clinical context.