The Silent Crisis of Aortic Valve Disease

A quiet health crisis is affecting millions of Americans, particularly those over the age of 65. It’s not a virus or a cancer; it’s a slow and steady deterioration of a vital valve in your heart. This condition occurs when the aortic valve opening narrows, restricting blood flow from the left ventricle to the aorta. Known as aortic valve disease—specifically aortic stenosis—it often goes undetected until it reaches a critical stage.

Experts refer to this as a “silent crisis” because the symptoms are frequently dismissed as normal signs of aging. Fatigue, shortness of breath and reduced stamina are easy to rationalize when you’re in your 70s or 80s. However, dismissing these signs can be deadly, they warn.

By combining advanced diagnostics with pioneering, catheter-based treatments, specialists at Baptist Health Miami Cardiac & Vascular Institute, are helping patients with advanced valvular disease regain their quality of life.

Understanding the Heart’s Mechanics

The heart uses four valves to direct blood flow in and out of each chamber: the aortic, mitral, tricuspid and pulmonary valves. The aortic valve plays a specific and vital role. It opens to allow oxygen-rich blood to travel from the heart to the rest of the body and closes to prevent that blood from leaking backward.

When this valve functions correctly, the process is seamless. However, disease or structural deficiencies can disrupt this flow. Aortic stenosis is the most common and serious form of this condition in older adults, says Nish Patel, M.D., an interventional cardiologist and director of the Structural Heart Program at Miami Cardiac & Vascular Institute. The process is largely mechanical, he says.

“With every single heartbeat, those valves are opening and closing,” Dr. Patel explains. “All that constant opening and closing, along with the high pressures of your heart’s chambers, creates wear and tear on your valves. This creates calcium deposits, which can restrict the opening of the aortic valve and cause aortic stenosis.”

Dr. Patel notes that the incidence of aortic stenosis rises sharply with age. It affects approximately 1 percent of the population after age 65, 3 percent after age 75, and 10 percent after age 85.

Why Aortic Valve Disease is “Silent”

The term “silent” refers to the deceptive nature of the disease progression. Unlike a heart attack, which often presents with sudden and undeniable pain, aortic valve disease advances slowly over years.

There are several reasons why this condition flies under the radar, Dr. Patel says:

• Gradual Onset: The narrowing of the valve happens incrementally. The body often adapts to the reduced blood flow for a long time, masking the severity of the problem.
• Attribution to Aging: Patients often assume that slowing down is simply a part of getting older.
• Lack of Screening: Primary care screenings for valve disease can be inconsistent, and heart murmurs—a primary indicator—may go unnoticed without careful auscultation (listening with a stethoscope).

Because the symptoms masquerade as general fatigue or deconditioning, many patients do not seek help until the disease is advanced. Statistics suggest that severe symptomatic aortic stenosis, if left untreated, has survival rates comparable to some advanced cancers. Once symptoms begin, the average survival without valve replacement may be only two to three years.

Identifying the Symptoms of Aortic Valve Disease

Recognizing the warning signs is the first line of defense. While the disease can be asymptomatic for years, the body eventually signals that the heart is struggling to pump blood through the narrowed valve.

Common symptoms of aortic valve disease include:

• Fatigue: extreme tiredness after activity that was previously easy
• Shortness of Breath: difficulty breathing during exertion or when lying flat
• Chest Pain or Tightness: a sensation of pressure or pain in the chest during activity
• Dizziness or Lightheadedness: feeling faint, particularly during exercise
• Swollen Ankles and Feet: signs of fluid retention caused by heart strain
• Irregular Heartbeat: palpitations or the sensation of a racing heart

Dr. Patel emphasizes that these symptoms should never be ignored, regardless of a patient’s age.

“These symptoms may be associated with underlying valvular heart disease. So, anytime a patient 65 and above has these symptoms, they should seek a cardiology evaluation.”

Assessing Your Risk Factors

While wear and tear is the primary driver of aortic stenosis in older adults, several factors can increase the likelihood of developing the disease. Understanding your personal risk profile is essential for proactive heart health.

The primary risk factors for aortic valve disease include:

• Age: The risk increases significantly for those over 65
• Family History: Having relatives with aortic aneurysms or heart valve disease increases susceptibility.
• Smoking: Tobacco use is a major cause of vessel damage and aneurysm formation.
• High Blood Pressure and Cholesterol: These conditions weaken the aortic wall and contribute to arterial damage.
• Congenital Conditions: Some people are born with a bicuspid aortic valve (two leaflets instead of three), which is more prone to stenosis.
• Genetic Conditions: Disorders such as Marfan syndrome or Loeys-Dietz syndrome affect the connective tissues of the heart and vessels.

Ramon Quesada, M.D., interventional cardiologist, medical director of cardiovascular innovation and research at Baptist Health Miami Cardiac & Vascular Institute, part of Baptist Health Heart & Vascular Care, stresses the importance of understanding these risks early.

“Many patients believe heart disease is solely about clogged arteries but structural issues like valve disease are just as critical,” Dr. Quesada says. “If you have a history of smoking or high blood pressure, you are not just risking a heart attack; you are compromising the mechanical integrity of your heart valves. Awareness of these risk factors is the first step toward prevention and early detection.”

Detection and Diagnosis of Aortic Valve Disease

Detecting aortic valve disease typically begins with a physical exam. A physician listening to the heart may hear a murmur — an unusual whooshing or swishing sound caused by turbulent blood flow across the narrowed valve.

If a murmur or other symptoms are present, physicians utilize advanced imaging to confirm the diagnosis and assess the severity of the stenosis.

Diagnostic tools include:

• Echocardiogram: This ultrasound of the heart is the gold standard for diagnosing valve disease. It allows doctors to visualize the valve leaflets and measure blood flow
• CT Scan: A computed tomography scan provides detailed 3D images of the heart and aorta, helping physicians plan procedures
• Cardiac Catheterization: In some cases, a catheter is threaded into the heart to measure pressures directly.

“If the cardiologist or other primary care physician finds something unusual, such as a murmur, they will arrange an echocardiogram for the patient,” explains Dr. Patel. “This will tell us if there are any issues with any of the valves.”

Innovation in Treatment: The TAVR Revolution

Historically, replacing a damaged aortic valve required open-heart surgery. This involved a large incision, stopping the heart, and a lengthy recovery period. While effective, the risks were often too high for older, frail patients.

Today, the landscape of treatment has shifted dramatically due to the advent of Transcatheter Aortic Valve Replacement (TAVR). This minimally invasive procedure allows doctors to replace the diseased valve without opening the chest.

During a TAVR procedure, interventional cardiologists insert a catheter through a blood vessel in the leg or sometimes the chest. A collapsible replacement valve is guided through the catheter to the site of the old valve. Once in place, the new valve expands, pushing the old valve leaflets out of the way and taking over the job of regulating blood flow.

Dr. Quesada has been a pioneer in this field, leading national clinical trials that have established TAVR as a standard of care.

“We have moved from an era of major surgery to one of precision and rapid recovery,” says Dr. Quesada. “TAVR allows us to treat patients who were once considered inoperable. By utilizing catheter-based techniques, we can repair the heart’s structure with minimal trauma to the body. Patients who would have faced months of recovery are often home within days, feeling an immediate difference in their breathing and energy levels.”

Miami Cardiac & Vascular Institute has performed more than 1,500 TAVR procedures, and it’s not just patients in their 70s, 80s or 90s that are finding relief. One recent patient was 103 when she underwent minimally invasive aortic valve replacement at the Institute last year—and she’s still going strong.

A Multidisciplinary Approach to Care

Treating structural heart disease requires a team effort. At Miami Cardiac & Vascular Institute, the complexity of aortic valve disease is managed through a specialized Valve Clinic. This model ensures that patients receive a comprehensive evaluation from multiple experts in a single visit.

“It is a multidisciplinary clinic where the structural heart specialist and the cardiothoracic surgeon see the patient on the same day, and they would have the appropriate test done prior to that appointment,” says Dr. Patel. “When the patient leaves the office visit, they have a plan on how to approach their valvular heart disease after having a comprehensive evaluation.”

This collaborative approach allows the team to tailor treatments to the individual. While TAVR is excellent for many, some patients may still benefit from surgical repair or other interventions.

Dr. Quesada adds that the depth of experience at the Institute is what truly sets it apart.

“Our community of structural heart specialists is dedicated to innovation—not for the sake of technology, but for the sake of the patient,” Dr. Quesada notes. “Whether it is aortic valve replacement, mitral valve repair or complex defect closures, our goal is to ensure that every patient—no matter their age or background—receives compassionate, personalized, and technologically advanced treatment.”

Taking Action for Heart Health

The silent nature of aortic valve disease makes proactive health management essential. Dr. Patel recommends five steps to protect your aorta and heart valves:

1. Get Screened: If you’re over 65 or have a family history of heart disease, ask your physician to listen for a murmur.
2. Control Blood Pressure and Cholesterol: Managing these numbers reduces stress on the heart valves and arteries.
3. Quit Smoking: Eliminating tobacco is one of the most impactful decisions for cardiovascular health.
4. Maintain a Healthy Lifestyle: Regular exercise and a balanced diet support overall heart function and weight management.
5. Know the Signs: Be vigilant about symptoms like shortness of breath or fatigue and report them to a physician immediately.

One way to understand your personal risk of developing heart disease is to get a heart scan. In just 30 minutes, a non-invasive CT scan can uncover risks you didn’t even know existed. Talk to your doctor and see if a heart scan is right for you. Visit BaptistHealth.net/HeartScan or call 833-596-2473 to find out more.