You know it’s getting worse. Even if you don’t say it out loud. Aortic valve stenosis is progressive. The narrowing doesn’t pause. It tightens. So the biggest trap? Assuming your fading energy is just the price of getting old. It usually isn’t.
The Difference Between Old and Sick
Gilbert Hin-Lung Tang, MD runs the structural heart program at Mount Sinai. He doesn’t ask how you feel today. Not really. He looks backward.
“What I always recommend is looking at what they were doing six or twelve months ago,” he says. If you climbed two flights then, but struggle with one now, that is data. Not just ‘I’m tired’ data. Functional decline.
Less energy overall? Sure. Happens to everyone eventually. But unusual fatigue after walking a short distance? Or shortness of breath doing laundry? Those aren’t senior moments. That’s the heart screaming that it can’t keep up with your daily routine.
Other red flags pop up, too:
- Chest pressure
- Ankle swelling that won’t quit
- Heart fluttering (palpitations)
- Trouble sleeping flat
- Lightheadedness
These signal that the valve is losing ground.
Why Tracking Matters (Even When You Feel Fine)
Here’s the problem: aortic stenosis is a slow burn. You might think you’re stable. You’re not. The only hard proof of progression is an echocardiogram. Tang notes this is the “only way” to actually see the disease advance.
But scans don’t happen daily. That leaves gaps. Huge ones.
Mackram F. Eleid, an interventional cardiologist at Mayo Clinic, suggests a fix. Routine. Stick to it.
“Having a regular exercise routine… they have something they can look back on,” Eleid explains. If you walk every morning, or do water aerobics, or climb a specific set of stairs, you establish a baseline. You know what ‘normal’ feels like for you. When normal starts feeling like hard labor, you have evidence.
The tricky part? People who are sedentary. If you’ve barely moved for years, you have no baseline to break. Tracking becomes guesswork.
How to Monitor Without a Lab Coat
You don’t need an MRI to watch the decline. You just need attention.
“A lot of people say, ‘I am doing fine,’ but when we ask… they were swimming twice as much before.”
— Dr. Tang
Here is how to get that data.
Keep a Journal
Digital or paper. Doesn’t matter. Just log it every day. Be specific. Vague feelings don’t help doctors; specifics do. Record:
- Date
- Symptom severity (1–5 or mild/severe)
- The exact activity when it hit (e.g., “walking to the mailbox”)
- Duration
- Did you stop? Did you sit down?
This creates a narrative. It shows the slide. A new nap at 3 PM might seem innocent. In your journal, it’s a marker. A change from six months ago. That’s disease progression.
Watchables and Smartwatches
Your smartwatch knows more about your heart than you think. It tracks resting heart rate. Steps. Sleep quality. Even heart rhythm.
Why does this matter? Fatigue might correlate with lower step counts. A creeping up of resting heart rate means your heart is working harder just to stay at baseline.
Palpitations are huge. Often, they flag atrial fibrillation before you feel chest pain.
“Developing palpitations becomes a marker of disease progression,” Tang says. Your heart is stressed even if you don’t feel the strain yet.
Just be careful. Dark nail polish? Cold fingers? Poor fit? The tech gets confused. It’s data, not gospel. Use it alongside your journal.
Pulse Oximeters
Cheap. Effective. You clip it on a finger. It tells you oxygen saturation and pulse.
Normal is 95-100%.
Below 92%? Call the doc.
88% or lower? Emergency. Your body isn’t getting oxygen.
When breathlessness strikes, check the number. Log it. Context helps. Was this during rest or exertion? Cold skin can skew readings, so warm up if needed.
When to Skip the Log and Call 911
There are times when tracking stops. When action starts.
Eleid is clear on the triggers for immediate medical attention:
- Fainting
- Sudden, severe chest pain
- Extreme shortness of breath
These three require evaluation now. Not tomorrow. “Generally,” Eleid warns, “once symptoms start and a patient has severe stenosis… outcome is not good” without intervention. Specifically, replacing the valve.
Symptoms aren’t a nuisance. They are the finish line. They tell you the window is closing. Track them. Watch them. Don’t assume the decline is natural. It’s likely the valve.
What are you telling your body it can handle, versus what it can’t? The difference is where you catch it.
