How to Track Your Daily Symptoms With Aortic Valve Stenosis

“We don't just ask patients ‘How are you feeling now?’” says Gilbert Hin-Lung Tang, MD, the surgical director of the structural heart program at the Mount Sinai Health System in New York City. “We ask what they were doing six months or a year ago, to see the changes in their activity level over time.”

Tracking your symptoms and functional changes over time is the best way to partner with your healthcare provider to protect your heart health — and catch any worsening disease early.

It’s easy to assume that “slowing down” is just part of getting older. “The reality is that a significant number of patients are actually slowing down because their heart can't keep up,” Dr. Tang says.

While less energy overall is a normal part of aging, unusual fatigue and shortness of breath during routine tasks or light activity, such as climbing stairs or walking short distances, are not.

“If six months ago a patient could go up two flights of stairs, and now they can only make it up one flight before needing a break, that's a marker of reduced exercise capacity,” Tang says.

• Chest discomfort or pressure
• New or worsening ankle or foot swelling
• Heart fluttering
• Difficulty sleeping
• Lightheadedness or dizziness

The slow, progressive nature of aortic valve stenosis can make it challenging to track without diagnostic tools.

“The only way to actually track valve disease progression is with an echocardiogram every few months to reassess severity or decline in heart function,” Tang says. “There's really no other way to see the progression.”

But day-to-day symptom tracking adds useful data between scans, especially if frequent echocardiograms aren’t possible.

“What I always recommend is just having a regular exercise routine that patients continue over a long period of time,” says Mackram F. Eleid, MD, an interventional cardiologist with Mayo Clinic in Rochester, Minnesota. “They have something that they're used to doing that they can look back on and say, ‘You know, something is different.’”

This routine can be as simple as regularly walking, climbing stairs, or engaging in low-impact or low-intensity exercises like yoga or water aerobics.

“The ones that are tricky are the patients who are very sedentary and have been that way for many years,” Dr. Eleid says. “In that case, it's very difficult in terms of tracking things.”

The following tips can help you monitor symptoms and uncover patterns to discuss with your doctor.

Keep a Symptom Journal

• The date
• The symptom and its severity (mild/moderate/severe, or on a 1–5 scale)
• What activity you were doing, including whether it stopped you or made you take a break
• The time it occurred
• How long the symptom lasted

This information will show your provider how your health has changed over time.

“A lot of people will say, ‘I have some symptoms, but I'm doing fine,’” Tang says. “But when we ask how they did 6 to 12 months ago, they were doing a lot more — walking, running, swimming, climbing stairs, twice as much. Now they're not able to do that, or there are other subtle symptoms, like needing a nap when they didn't before. Those are markers of disease progression.”

Consider Wearable Tech (Smartwatches)

• Resting heart rate
• Heart rate during exertion
• Heart rhythm
• Physical activity (steps taken, distance moved, calories burned)
• Sleep quality
• Blood oxygen

Depending on the model, these devices can often be set up to provide you with daily or immediate notifications about these measurements. Logging them alongside your symptoms can show, for example, how fatigue or breathlessness may affect steps or whether your resting heart rate is creeping up over time (showing how much harder your heart is working to pump blood).

Use a Pulse Oximeter

According to Tang, wearable tech and pulse oximeters can add useful data to your symptom journal, but he recommends not relying on them solely since many factors can throw off readings.

Eleid advises seeking immediate medical attention (call 911) if you experience:

• Fainting
• Sudden, severe chest pain
• Extreme shortness of breath

“Those three symptoms should prompt evaluation,” he says. “Generally, once symptoms start and a patient has severe aortic stenosis, the outcome is not good unless they have an intervention, which is replacing the valve.”