VHOSPITAL.CLINIC · Differential Diagnosis
Aortic Stenosis vs Heart Failure
Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.
Condition Overview
Condition A
Aortic Stenosis
Aortic stenosis is narrowing of the aortic valve opening, restricting blood flow from the heart. It causes exertional chest pain, syncope, and heart failure; valve replacement is required for severe symptomatic disease.
Condition B
Heart Failure
Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It is a chronic condition that causes fatigue, shortness of breath, and fluid retention (edema). It requires ongoing medical management.
Shared Symptoms — Why They're Confused
Both conditions present with 4 overlapping symptoms, making clinical differentiation essential.
Key Clinical Differences
Aortic Stenosis
- Exertional syncope, angina, and dyspnoea (classic triad)
- Ejection systolic murmur radiating to carotids
- Slow-rising, low-volume carotid pulse
- Symptoms appear late — poor prognosis without valve replacement
Heart Failure
- Dyspnoea on exertion, orthopnoea, PND
- Bilateral basal crackles, raised JVP, peripheral oedema
- S3 gallop rhythm
- Cardiomegaly on CXR
Distinguishing Diagnostic Tests
| Test | Aortic Stenosis | Heart Failure |
|---|---|---|
| Echocardiography | Thickened calcified aortic valve, reduced AVA (<1 cm²), high gradient | Reduced EF or diastolic dysfunction; dilated ventricle without valvular stenosis |
| CXR | Normal heart size; may show aortic valve calcification | Cardiomegaly, pulmonary venous congestion, Kerley B lines |
| BNP/NT-proBNP | May be elevated if severe AS leads to secondary HF | Markedly elevated — proportional to degree of HF |
Treatment Approaches
Aortic Stenosis
- •Aortic valve replacement (SAVR or TAVI)
- •Medical optimisation while awaiting intervention
Heart Failure
- •ACE inhibitors/ARBs, beta-blockers, diuretics
- •Cardiac resynchronisation therapy if indicated
- •Implantable defibrillator for low EF
When Doctors Consider Each Diagnosis
🔵 Consider Aortic Stenosis when:
- →Exertional syncope, ejection systolic murmur, calcified valve on echo
🟢 Consider Heart Failure when:
- →Orthopnoea, peripheral oedema, S3, elevated BNP, dilated cardiomegaly
Explore Each Condition in Detail
Related Clinical Pages
Aortic Stenosis
Medical References
Content on this page is informed by evidence-based clinical sources including:
- World Health Organization (WHO)Global health guidance and disease classification
- National Health Service (NHS)UK clinical guidelines and patient information
- National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
- Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
- PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
- Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine
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