Angina occurs when your heart does not get enough oxygen-rich blood
through the coronary arteries, which are the vessels that supply the heart with
blood. Your heart hurts because it is starved for oxygen, a condition called
myocardial ischemia. Because your heart needs more blood when you are
physically active, you will typically experience angina during exercise or
other physical activities.
About two-thirds of people who have severe aortic valve stenosis
experience angina. About half of those people also have coronary artery disease
(CAD), a narrowing of the coronary arteries that is caused by the buildup of
hard plaque (atherosclerosis). Angina may be worse in people who
have both aortic valve stenosis and CAD and is one of the ways that CAD can
make aortic valve stenosis more dangerous.
In the same way that aortic valve stenosis prevents enough blood
from reaching the heart, it can also prevent your heart from pumping enough
blood to your brain. Without enough blood, your brain cannot maintain
consciousness. Before actually blacking out or fainting, you may experience
dizziness or "graying out," which is a brief blurring of vision. Although
fainting occurs while you are exerting yourself, you may also experience it
when you are at rest, which can result from an irregular heartbeat that comes
and goes in association with advancing heart failure.
The irregular contraction of your heart can occur in your ventricle
or your atrium, either of which can significantly affect your heart's ability
to pump enough blood. This irregular heartbeat generally returns to normal on
its own, at which point you will recover from the syncope.
Shortness of breath (dyspnea)
Shortness of breath is actually a symptom of heart failure that
occurs when blood begins to back up into the stiff or failing left ventricle.
This blood raises the pressure in the vessels that carry blood between the
heart and the lungs (pulmonary hypertension). And extra fluid builds up in the
lungs (pulmonary congestion). The extra fluid interferes with the exchange of
oxygen for carbon dioxide in the blood.
Shortness of breath is most common during physical exertion. But
shortness of breath can also occur suddenly during your sleep (paroxysmal
nocturnal dyspnea). You may also have difficulty breathing when you are lying
Other symptoms of heart failure
Although dyspnea is generally an indication of significant heart
failure, other symptoms of heart failure can occur in the most advanced stages
of aortic valve stenosis. These include pulmonary edema, which is fluid in the
lungs that causes coughing, wheezing, and difficulty breathing as well as
fatigue and physical weakness.
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