Shortness of Breath & Heart Murmurs: The Hidden Risk of Valve Disease

"I'm just slowing down because I'm getting older."

I hear this phrase in my clinic almost every day. A 70-year-old patient tells me they’ve stopped golfing because they get "winded." Or they’ve stopped carrying groceries because it feels "too heavy." They think it’s normal aging.

Often, it is not. It is the sound of a heart valve slowly failing. We sometimes hear a "murmur" when we listen to the heart. The most commonly heard murmur is aortic stenosis, but there can be otehrs. Teh others are much harder to hear.

What Is Heart Valves Disease?

Valvular Heart Disease is the silent epidemic of the aging population. Unlike a heart attack, which strikes with sudden chest pain, valve disease creeps up on you over years. It steals your energy, your breath, and eventually, your independence.

But here is the good news: We can fix it easier than ever before.

The Two Main Culprits: Aortic Stenosis & Mitral Regurgitation

Your heart has four valves that act as one-way doors, keeping blood flowing in the right direction. As we age, two of them are prone to failure.

1. Aortic Stenosis (The "Stiff Door")

The aortic valve is the main exit door from your heart to the rest of your body. Over time, calcium deposits can build up on this valve—much like rust on a hinge.

• The Problem: The valve becomes narrow and stiff (stenosis). Your heart has to generate massive pressure to push blood through this tiny opening.
• The Symptoms: Shortness of breath, chest pressure during exercise, and feeling lightheaded or dizzy.
• The Danger: Once you have symptoms, the clock starts ticking. Without treatment, the survival rate for severe aortic stenosis is worse than many cancers.

2. Mitral Regurgitation (The "Leaky Door")

The mitral valve sits between the two chambers on the left side of your heart. Sometimes, the valve flaps become "floppy" (Prolapse) or fail to close tightly.

• The Problem: Every time your heart pumps, some blood leaks backward into your lungs instead of going forward to your body.
• The Symptoms: Chronic fatigue, palpitations (fluttering heart), and waking up at night gasping for air.

Causes Of Aortic Stenosis

One major cause of aortic stenosis is elevated lipoprotein a, sometimes called lipoprotein little a or Lp(a). This causes calcific aortic valve disease, or CAVD. Unfortunately, we wait too long to look for Lp(a) and sometimes only realize that patients have lipoprotein a when they are diagnosed with aortic stenosis and need a new valve.

The "Watch and Wait" Trap

Many patients are told they have a "heart murmur" decades ago and ignore it. This is dangerous. A murmur is just the sound of blood turbulence. You need to know the cause.

As a cardiologist, I don't just listen. I measure. We use Echocardiograms to track the speed of blood flow across the valve.

• Mild/Moderate: We monitor closely and optimize your blood pressure to take the strain off the valve.
• Moderate: We sometimes now recommend valve replacement even at the moderate level due to advancements in technology
• Severe: We plan for intervention before permanent heart damage occurs. But sometimes it's not diagnosed until it is too late.

The Game Changer: You Likely Don't Need "Open Heart" Surgery

The biggest fear my patients have is having their chest cracked open (sternotomy). In 2025, that is often unnecessary.

Enter TAVR (Transcatheter Aortic Valve Replacement). For Aortic Stenosis, we can now replace the valve through a small puncture in your leg artery—similar to placing a stent.

• No big scar.
• No heart-lung machine.
• Home in 24-48 hours.

I have seen patients in their 80s undergo TAVR on a Tuesday and be back to walking their dog by the weekend. It is nothing short of a medical miracle.

Dr. Alo’s Advice: When to Get Checked

If you (or your parents) have any of these three "Red Flags," you need an echocardiogram immediately:

1. Exertional Dyspnea: You get out of breath walking up a flight of stairs that used to be easy.
2. The "Slow Down": You are subconsciously avoiding activities you used to love because they feel "hard."
3. Swollen Ankles: This can be a sign that a leaky valve is causing fluid backup.

Don't accept "getting old" as a diagnosis. Your heart might just need a new door.