A few decades ago, growing older was often viewed as something to accept rather than actively manage. Slower days, less movement and lower energy were simply explained away as “age.” Today, that conversation has changed. Healthy ageing is increasingly about disease prevention, preserving independence and maintaining quality of life.
The World Health Organization (WHO) defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” Heart health is central to preserving that freedom. Yet discussions usually focus on cholesterol, blood pressure and blocked arteries. A quieter, but equally important, aspect of heart health often receives far less attention — the heart valves.
The heart beats nearly 2.5 billion times during an average lifetime, continuously pumping blood to every organ and tissue. About the size of two clasped hands, it relies on four valves that open and close with every heartbeat, ensuring blood flows in the correct direction. As we age, these valves can gradually become thickened, stiff or narrowed. One of the most common and serious valve disorders is aortic stenosis, a condition in which the aortic valve narrows, restricting blood flow from the heart to the rest of the body. The American Heart Association recognises aortic stenosis as one of the most common and potentially serious forms of heart valve disease.
Unfortunately, heart valve disease often remains outside the healthy ageing conversation until symptoms begin to interfere with everyday life. Heart valve disease is missed because it usually develops slowly. According to the National Heart, Lung and Blood Institute (NHLBI), symptoms may include fatigue, shortness of breath, chest pain, dizziness or fainting. The challenge is not merely medical; it is also cultural. Many older adults gradually adapt to declining stamina without realising that something may be wrong. They walk shorter distances, climb fewer stairs, avoid physical activity or take more frequent rests. Families often notice these changes but may attribute them to normal ageing rather than an underlying heart condition. Healthy ageing conversations should make room for these subtle changes, particularly when breathing, stamina or confidence in everyday activities begins to decline.
Sometimes the first clue comes during a routine physical examination. A doctor may hear a heart murmur — an unusual sound produced by turbulent blood flow across a diseased valve. An echocardiogram, a painless ultrasound examination of the heart, can then assess how well the valves open and close and how effectively the heart is functioning. Early diagnosis gives patients and families valuable time to understand the condition, monitor its progression and discuss treatment before symptoms become severe or treatment options become more limited.
Treatment for severe aortic stenosis has advanced considerably over the past decade. Selected patients may be suitable for Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure in which a new valve is delivered through a thin catheter, usually inserted through a blood vessel in the leg, without the need for conventional open-heart surgery. However, there is no one-size-fits-all approach to valve disease. The best treatment depends on a comprehensive assessment that considers the severity of symptoms, valve anatomy, age, overall health, frailty, expected quality of life, personal goals and long-term care planning.
Long-term care remains essential after any valve intervention. Patients require regular follow-up, adherence to prescribed medications, good control of blood pressure and diabetes, meticulous dental hygiene and prompt medical attention if they develop worsening breathlessness, chest discomfort, dizziness, fainting, fever or a sudden decline in energy levels.
Healthy ageing prompts many important questions. How strong are the bones? Is diabetes under control? How good is memory? How healthy is the heart? There is one more question that deserves equal attention: How healthy are the heart valves? Regular health check-ups, paying attention to changes in stamina or breathlessness, timely medical consultation and an echocardiogram when indicated can help preserve mobility, independence and quality of life. Heart valve health deserves to be an integral part of any conversation on minimising risk.
(The author is a professor of Cardiology and an Interventional Cardiologist, Christian Medical College [CMC], Vellore)
