Aortic Stenosis (Narrowed Aortic Valve) in Singapore

Written & reviewed by the BestDoctors.sg editorial team · Last updated 1 Sep 2026 · General information, not medical advice

Aortic stenosis often develops silently over years, so the moment symptoms appear is an important turning point. Recognising them – and getting an echocardiogram – is what gets people to effective treatment in time. This guide explains what aortic stenosis is, who is most at risk, what can happen if it is left untreated, how it is diagnosed and treated in Singapore, and how to live with it safely.

What it is

The aortic valve normally opens to let blood leave the heart and closes to stop it flowing back. It usually has three thin flaps (leaflets). In AS the valve becomes stiff and its opening narrows, so the left ventricle – the heart’s main pumping chamber – must generate higher pressure to push blood through. Over time this extra work strains and thickens the heart muscle, and can progress to heart failure. The narrowing is graded on a scan as mild, moderate or severe, and tends to worsen gradually over years.

Causes

The most common cause is degenerative calcification – calcium deposits from years of wear and tear, usually becoming significant from around the seventh decade of life, which is why AS is chiefly a disease of older adults. A congenital bicuspid aortic valve (two leaflets instead of the normal three) is present from birth and tends to degenerate and narrow earlier, often in middle age. Rheumatic heart disease, a late consequence of untreated streptococcal infection, is another cause, more common in older generations and in the region.

Who is at risk

You are more likely to develop aortic stenosis if you:

• are older – risk rises steadily with age, especially past 65–70;
• were born with a bicuspid aortic valve, or have a family history of it;
• have had rheumatic fever or rheumatic heart disease;
• have cardiovascular risk factors – high blood pressure, high cholesterol, diabetes or smoking, which share the same processes that stiffen and calcify the valve;
• have had chest radiotherapy or chronic kidney disease, both linked to faster valve calcification.

Symptoms – often on exertion

AS is frequently silent for years – some people, particularly if sedentary, remain symptom-free even with significant narrowing. When symptoms develop they classically come on with exertion and ease with rest. The three classic ones are:

• Chest pain or tightness (angina) on exertion;
• Breathlessness – on activity, and later even at rest or lying flat;
• Dizziness, light-headedness or fainting (blackouts), typically during exertion.

Other clues include unusual fatigue, reduced ability to exercise, and palpitations. Because people often slow down without realising it, symptoms can be missed or blamed on ageing. The onset of any of these is an important warning that the disease has reached a higher-risk stage and needs prompt evaluation.

Complications if it is not treated

Once severe AS causes symptoms, the outlook without treatment is poor, which is why timely valve replacement matters. Untreated or advanced disease can lead to:

• Heart failure – the strained heart muscle eventually struggles to keep up, causing breathlessness and fluid build-up.
• Fainting and falls – sudden drops in blood flow to the brain, with a risk of injury.
• Abnormal heart rhythms – including atrial fibrillation, which can further reduce the heart’s efficiency.
• Sudden cardiac death – a recognised risk in severe symptomatic disease.
• Infective endocarditis – an abnormal valve is more prone to infection.
• Pulmonary hypertension – raised pressure in the lung circulation as the problem backs up.

How it’s diagnosed

A doctor may first detect an abnormal heart murmur on listening to the chest. The key confirmatory test is an echocardiogram (ultrasound of the heart), which confirms AS, shows how well the heart is pumping, and grades severity as mild, moderate or severe. Other tests help complete the picture and plan treatment:

• ECG and chest X-ray – to look at the heart’s rhythm, strain and size;
• Exercise (stress) testing – sometimes used, carefully, to check for hidden symptoms in people who claim to have none;
• CT scan – to assess the valve and blood vessels, and to plan a TAVI procedure;
• Cardiac catheterisation / angiogram – to check the coronary arteries before valve surgery.

In Singapore, echocardiography and these tests are widely available through cardiology services at public and private hospitals.

Treatment

No medication can reverse or cure aortic stenosis – the only definitive treatment is to replace the valve. Management depends on severity and symptoms:

• Mild or moderate, and symptom-free: managed with regular monitoring (periodic echocardiograms) to track progression, plus control of blood pressure, cholesterol and other heart risks.
• Severe and symptomatic: the valve is replaced. The two main options are surgical aortic valve replacement (SAVR), an open-heart operation, and TAVI (transcatheter aortic valve implantation) – a catheter-based, minimally invasive procedure that implants a new valve without open surgery.

The choice between surgery and TAVI depends on age, overall health, surgical risk, the valve’s anatomy and personal preference. A specialist multidisciplinary heart team – such as those at the National Heart Centre Singapore and National University Heart Centre, Singapore – reviews each case and recommends the best approach. Looking after general heart health (blood pressure, cholesterol, not smoking, staying active as advised) supports any treatment.

Living with aortic stenosis

Many people live well with aortic stenosis, especially when it is monitored and treated at the right time. Practical points:

• Keep your monitoring appointments. Even without symptoms, regular echocardiograms track how fast the valve is narrowing and catch the moment intervention is needed.
• Report new symptoms promptly. New or worsening breathlessness, chest tightness, dizziness or fainting should trigger an early review – do not wait for the next scheduled visit.
• Ask about exercise. Light-to-moderate activity is usually encouraged in mild disease, but strenuous or competitive exertion may be limited in severe AS – follow your cardiologist’s advice rather than a generic plan.
• Look after your teeth and tell your dentist. Good dental hygiene lowers the risk of valve infection (endocarditis); mention your valve condition before dental or surgical procedures.
• Manage other heart risks – blood pressure, cholesterol, diabetes and smoking – as these speed valve damage and add to overall heart strain.

When to see a doctor

See a doctor for assessment if you have exertional chest pain, breathlessness, dizziness or fainting, or if a murmur has been noticed. If AS is diagnosed – especially severe or symptomatic disease – a cardiologist should be consulted promptly, as the outlook without treatment is poor.

Seek emergency care – call 995 in Singapore – for sudden severe chest pain, fainting or collapse, severe breathlessness, or stroke symptoms (face drooping, arm weakness, slurred speech).

Questions to ask your doctor

• How severe is my aortic stenosis, and how quickly is it likely to progress?
• Do I have symptoms that mean I need treatment now, or can it be monitored?
• How often should I have an echocardiogram?
• If I need the valve replaced, am I better suited to surgery or TAVI, and why?
• What activities or exercise are safe for me?
• What symptoms should prompt me to seek urgent help?

Related heart conditions & procedures

• Heart valve replacement & TAVI
• Aortic dissection
• Carotid artery disease
• Heart block & slow heart rate
• Infective endocarditis
• Rheumatic heart disease
• Pulmonary hypertension
• Heart bypass surgery (CABG)
• Cardiac catheterisation & angiogram
• Heart valve disease
• Coronary artery disease & angina
• Cardiologists in Singapore

Sources

• National University Heart Centre, Singapore (NUHCS) — aortic valve stenosis (definition; causes – calcific/bicuspid/rheumatic; symptoms; echocardiogram diagnosis; treatment; that untreated severe symptomatic AS is fatal).
• National Heart Centre Singapore (NHCS) — structural heart disease programme (multidisciplinary heart team; TAVI for severe symptomatic AS).
• SingHealth — TAVI patient information; UK NHS and healthdirect — corroboration of symptoms, risk factors, complications and monitoring.