By Dr Praveen Chandra | Padma Shri | Chairman, Interventional Cardiology, Medanta — The Medicity | Performed India’s first TAVI, 2010
Most of what is written about aortic stenosis explains what the condition is and how it is treated. Far less is written about how to live with it well in the meantime, the practical questions that patients and their families actually ask me in the clinic. Can I exercise? Is it safe to become pregnant? Should my children be checked? How often does this need watching? This guide is an attempt to answer those questions in one place, plainly and accurately. It is educational, and it is not a substitute for your own cardiologist’s advice, but it should help you ask better questions when you see them.
Should my family be checked?
If your aortic stenosis is related to a bicuspid aortic valve, a valve you were born with that has two cusps instead of the usual three, then this question matters a great deal, because a bicuspid valve tends to run in families. Current cardiology guidelines recommend that the first-degree relatives of a person with a bicuspid valve, that is, parents, brothers and sisters, and children, undergo a screening echocardiogram, even if they feel completely well and have no symptoms whatsoever.
The reason is simple. A bicuspid valve can be present and function quietly for decades before it causes any problem. Finding it early changes nothing about how that relative feels today, but it allows their heart to be watched sensibly over the years, so that if the valve does begin to narrow or leak, it is caught in good time rather than late. The test is painless, takes only minutes, and is widely available. If a bicuspid valve has been identified anywhere in your immediate family, it is worth asking your cardiologist whether you and your relatives should be screened.
Can I exercise?
One of the most frequent questions I receive in the clinic is whether lifestyle changes can reverse a narrowed heart valve. To answer this, we must first understand the root cause: in the vast majority of patients, Severe Aortic Stenosis is simply a disease of time. Over decades, the constant mechanical stress of blood pumping through the valve leads to calcium deposits, causing the leaflets to stiffen and restrict flow.
Because this calcification is an age-related, mechanical process, let me be very clear: no amount of exercise and no specific diet can dissolve the calcium or widen the valve. However, a healthy lifestyle remains absolutely critical. Controlling your blood pressure, managing cholesterol and diabetes, and abstaining from smoking will not fix the valve itself, but it protects the rest of your cardiovascular system and ensures your heart is strong enough to undergo future interventions.
On activity itself, the guidance varies by severity. In mild and moderate aortic stenosis, regular activity is not only safe but encouraged; walking, light cycling, swimming and similar moderate exercise are good for you. In severe aortic stenosis, the picture changes. A severely narrowed valve cannot suddenly increase the blood flow the body demands during intense exertion, and it is during strenuous or competitive activity that the rare but serious problems, fainting, and very occasionally worse can occur. For this reason, patients with severe aortic stenosis are generally advised to avoid strenuous and competitive exercise, while remaining gently active within comfortable limits.
The safe boundary is genuinely individual. The sensible course is to ask your cardiologist what level of activity is right for your particular valve, rather than guessing in either direction.
“You cannot exercise away a narrowed valve. But staying gently active, within the right limits, is good for the rest of your heart.”
Is it safe to become pregnant?
For a woman with a known heart valve condition who is planning a family, this is among the most important questions she will ask, and the timing of the answer matters as much as the answer itself. Pregnancy places a substantial additional demand on the heart; the volume of blood it pumps rises significantly over the course of nine months, and continues to be demanding through labour and the period after delivery.
A valve that is only mildly affected usually tolerates pregnancy well, with appropriate monitoring. A significantly narrowed valve is a different matter, and severe aortic stenosis is regarded as a higher-risk condition in pregnancy precisely because the valve may not be able to meet the increased demand. None of this means that pregnancy is impossible; it means that it should be planned and understood in advance.
The single most valuable step is a cardiac assessment before conception, not after. Seen ahead of time, a cardiologist can assess the valve fully, discuss the risks honestly, and consider whether anything should be done before a pregnancy begins, all in calm conditions, with time to make good decisions. If you have a known valve condition and are considering a family, the most important appointment is the one you make before you are pregnant.
How often does this need to be checked?
When a patient is diagnosed with Aortic Stenosis, their first question is usually, ‘How often do we need to check this?’
The answer lies in the echocardiogram, and the schedule depends entirely on the degree of the narrowing. If the stenosis is mild, we typically review it every three to five years. If it is moderate, we need to look at it once a year. But if the valve is severe, even if you feel perfectly fine, we mandate an echocardiogram every six to twelve months.
Of course, these are guidelines. If your symptoms change even slightly, we shorten that window immediately. Never leave the clinic guessing, always know exactly when your next scan is due.
I need an operation for something else. Does my valve matter?
Yes, and this is a point that genuinely protects patients. If you have severe aortic stenosis and are due to undergo any operation, including procedures entirely unrelated to the heart, such as a joint replacement, a hernia repair, gallbladder surgery, or even some eye procedures, your narrowed valve raises the risk associated with that surgery and its anaesthesia. The valve copes poorly with the sudden changes in blood pressure and fluid balance that surgery can involve.
The essential step is that your aortic stenosis is known to the surgeon and the anaesthetist well before the operation, and that a cardiologist is involved in the planning. In many cases the surgery proceeds safely with the right precautions; in some, the valve is best addressed first. Either way, the decision should be made deliberately and in advance. If you have significant aortic stenosis and any surgery is being considered, make sure your heart is part of that conversation from the very beginning.
Is aortic stenosis different in women?
In some important respects, yes. Aortic stenosis is sometimes under-recognised in women, symptoms such as breathlessness and fatigue can be attributed to other causes, and the disease can present later or less obviously than it does in men. There is also a genuine technical difference worth knowing about. When a CT scan is used to confirm the severity of the disease by measuring the amount of calcium on the valve, the threshold that defines severe disease is lower in women than in men. In practical terms, a woman’s valve can be seriously narrowed at a calcium level that would appear less concerning in a man, which is one reason the diagnosis can be missed if this is not accounted for.
The practical message is straightforward. A new or worsening breathlessness, fatigue or reduction in what a woman can comfortably do deserves the same thorough cardiac assessment it would receive in anyone. If something has changed in how you feel, it is worth having your heart properly evaluated rather than assuming the cause lies elsewhere.
After a valve replacement, why does my dentist matter?
This connection surprises almost every patient, and it is genuinely important. Once a heart valve has been replaced, whether through TAVI or through surgery, the replaced valve places the patient in the highest-risk category for a serious infection of the inner lining of the heart, a condition called infective endocarditis. This infection can be triggered when bacteria enter the bloodstream, and certain dental procedures are among the recognised routes by which that can happen.
For patients with a replaced valve, two things therefore matter. Good day-to-day dental hygiene, and antibiotic cover before specific dental procedures, as advised by the cardiologist and dentist together. It is important to understand the boundary here: this recommendation applies to a valve that has been replaced, not to a native valve that is simply narrowed and has not been treated. If you have had a valve replacement, tell your dentist about it, and ask your cardiologist whether you need antibiotics before dental treatment.
A final word
Living with aortic stenosis is, for most people, a matter of sensible vigilance rather than constant worry. The valve is watched on a schedule. Activity continues within the right limits. Pregnancy, other surgery, and family screening are planned rather than left to chance. And if and when the valve needs to be treated, the options available today are excellent. The thread running through all of it is the same: a good relationship with a cardiologist who knows your particular heart, and the willingness to ask the practical questions rather than assume the answers. I hope this guide helps you ask them.
“Living with this condition is, for most people, a matter of sensible vigilance, not constant worry.”
