Women are at a higher risk for paradoxical low flow low gradient (LFLG) severe aortic stenosis, a serious heart valve condition that can be difficult to detect due to differences in heart size and how the heart changes with age. A woman’s heart is typically 20% to 26% smaller and lighter than a man’s, and while men’s hearts tend to increase in size as they age, women’s hearts shrink over time.
Aortic stenosis is the narrowing of the aortic valve opening, which restricts blood flow from the heart to the rest of the body. The condition mostly affects people over 60 but often does not show symptoms until later decades. Common symptoms include heart murmur, shortness of breath, fatigue during activity, chest pain or pressure, and fainting.
Paradoxical LFLG severe aortic stenosis is one of three sub-groups of severe aortic stenosis. It impacts more women because of their smaller heart size but can also affect men. Jeffrey Cook, MD, interventional cardiologist at Blessing Health System, said: “The condition can be hard to recognize. Patients with this condition have thick, small heart chambers. The echocardiogram measurements you normally look at, for squeezing function of the heart, will most likely be in the moderate range and not the severe range. That’s because the patient’s smaller heart has lower blood flow and lower pressure readings to begin with and is not showing the true effects of the narrowing of the aortic valve opening.”
In typical cases of severe aortic stenosis, echocardiograms reveal low blood flow and high pressure across the valve. However, those with smaller hearts may display both low flow and low gradient on these tests—even when experiencing significant symptoms—making diagnosis more challenging.
Providers who do not frequently interpret echocardiogram results may find these moderate numbers misleading if they are unfamiliar with this specific subtype. This can result in delayed diagnosis and treatment as symptoms progress.
“If a patient or their provider notices classic symptoms of aortic stenosis but echocardiogram test results show only moderate severity – call the Blessing Valve Clinic. We can order a heart CT scan to help sort out what is happening,” Dr. Cook recommended.
Treatment for aortic stenosis involves replacing malfunctioning valves—a procedure traditionally performed through surgery. Amy Bates, APRN-AGACNP and Valve Clinic Coordinator at Blessing Health System stated: “Some people are not candidates for surgery due to other health conditions. That’s where TAVR – transcatheter aortic valve replacement – helps. It is a minimally invasive procedure during which a new heart valve is placed via a catheter, fed through the leg to the heart, using X-ray guidance.”
Dr. Cook performs TAVR procedures in partnership with surgeon Dr. John Arnold. According to Dr. Arnold: “The valve device deploys without having to stop the heart.”
Patients undergoing TAVR usually experience shorter hospital stays and faster recovery compared to surgical options.
Dr. Cook advised: “If you have had a heart murmur for a long time and start to feel fatigue and shortness of breath with activity, but your test results are not showing that is happening, ask your provider to refer you to the Heart Valve Clinic for specific LFLG severe aortic stenosis testing.”
For further information about LFLG severe aortic stenosis or services offered by Blessing Valve Clinic, individuals can contact 217-214-3444.
