Aortic stenosis causes: Difference between revisions

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**[[Pseudo-Hurler polydystrophy|Mucolipidosis III gamma]]
**[[Pseudo-Hurler polydystrophy|Mucolipidosis III gamma]]
**[[Onat syndrome]]
**[[Onat syndrome]]
**[[Aortic valve#Disease of the aortic valve|Quadricuspid aortic valve]]
**[[Quadricuspid aortic valve]]
**[[Singleton-Merten syndrome]]
**[[Singleton-Merten syndrome]]
**[[Sweet syndrome]]
**[[Sweet syndrome]]
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===Causes in Alphabetic Order===
===Causes in Alphabetical Order===
*[[Calcific aortic valve disease|Age-induced calcification]] of normal tricuspid aortic valve with [[Degeneration|degenerative 'wear and tear']]
{{col-begin|width=80%}}
*[[Congenital]] [[bicuspid aortic valve]]
{{col-break|width=33%}}
*[[Endocarditis]]
*[[3-Methylglutaconic aciduria|3-Methylglutaconic aciduria type 4]]
*[[Fabry disease]]
*[[Alkaptonuria]]
*Fryns-van den Berghe syndrome
*[[Aortic sclerosis]]
*[[Homozygous type II hypercholesterolemia]]
*[[Aortitis]]
*[[Bardet-Biedl syndrome]]
*[[Williams syndrome|Beuren-Williams syndrome]]
*[[Bicuspid aortic stenosis|Bicommissural aortic valve]]
*[[Bicuspid aortic valve]]
*[[Chromosome 15q partial deletion|Chromosome 15q deletion syndromes]]
*[[Fabry's disease]]
*[[Familial]]
*[[Familial thoracic aortic aneurysm|Familial thoracic aortic aneurysm syndrome]]
*[[Fryns-Van den Berghe syndrome]]
{{col-break|width=33%}}
*[[Homozygous familial hypercholesterolemia]]
*[[Hypertrophic cardiomyopathy]]
*[[Hyperuricemia]]
*[[Aortic valve#Disease of the aortic valve|Hypoplastic aortic annulus]]
*[[Hypoplastic left heart syndrome]]
*[[Idiopathic hypertrophic subaortic stenosis]]
*[[Infective endocarditis]]
*[[Loeys-Dietz syndrome]]
*[[Pseudo-Hurler polydystrophy|Mucolipidosis III gamma]]
*[[Ochronosis]]
*[[Ochronosis]]
*[[Paget disease]]
*[[Onat syndrome]]
*Prosthetic aortic valve
*[[Paget's disease]]
*[[Radiation treatment]] to the chest
*[[Aortic valve#Aortic Valve Replacement|Prosthetic aortic valve]]
*[[Rheumatic fever]] (slowly progressive stenosis)
{{col-break|width=33%}}
*[[Quadricuspid aortic valve]]
*[[Radiation]]
*[[Rheumatic fever]]
*[[Senile calcific aortic stenosis]]
*[[Singleton-Merten syndrome]]
*[[Singleton-Merten syndrome]]
*[[Subvalvular aortic stenosis]]
*[[Sweet syndrome]]
*[[Supravalvular aortic stenosis]]
*[[Systemic lupus erythematosus]]
*[[Williams syndrome]], [[autosomal dominant]] trait is associated with [[supravalvular aortic stenosis]]
*[[Aortic valve#Disease of the aortic valve|Tricuspid aortic valve with commissural fushion]]
*[[Turner syndrome]]
*[[Aortic valve#Disease of the aortic valve|Unicommissural aortic valve]]
*[[Aortic valve#Disease of the aortic valve|Unicuspid aortic valve]]
*[[Williams syndrome]]
{{col-end}}


==References==
==References==

Revision as of 21:48, 15 November 2013

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

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Prevention

Precautions and Prophylaxis

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]; Vendhan Ramanujam M.B.B.S [4]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]

Overview

Causes of aortic stenosis are either congenital or acquired, and its common causes vary between different age groups and between different human populations. While congenital bicuspid aortic valve is the most common cause of aortic stenosis in people below 70 years of age, acquired degenerative calcific aortic stenosis is the most common cause in older patients above 70 years of age. Rheumatic heart disease remains the most common cause of aortic stenosis worldwide and calcification, either degenerative calcification in older adults, or early calcification secondary to a congenital bicuspid aortic valve are the most common causes in North America.[1]

Causes

Valvular Aortic Stenosis

Subvalvular Aortic Stenosis

Supravalvular Aortic Stenosis

Frequency of Underlying Causes of Aortic Stenosis

According to the Euro Heart Survey[2] on valvular heart disease, the frequencies of the different underlying causes of aortic stenosis were the following:

  1. Calcific degeneration - 81.9%
  2. Rheumatic fever - 11.2% [9]
  3. Congenital - 5.6%
  4. Post-endocarditis - 1.3%

Causes of Aortic Valve Calcification:

  • Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases).
  • Other causes include:

Causes of More Rapid AS Progression:

  • Normal valves have three leaflets (tricuspid), but some valves have only two (bicuspid). Aortic stenosis due to calcification of a bicuspid valve typically becomes symptomatic in the 40s and 50s whereas that due to calcification of a normal valve manifests later in the 70s and 80s. Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process. [9]

Cause of Aortic Stenosis as a Function of Age

The cause of aortic stenosis will vary with age:[10][11]

  • Under Age 70:
    • Bicuspid aortic valve - 50%
    • Postinflammatory - 25%
    • Degenerative calcific - 18%
    • Unicommissural - 3%
    • Hypoplastic - 2%
    • Indeterminant - 2%
  • Over Age 70:
    • Degenerative calcific - 48%
    • Bicuspid - 27%
    • Postinflammatory - 23%
    • Hypoplastic - 2%

Complete Differential Diagnosis for the Causes of Aortic Stenosis

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Age-induced calcification of normal tricuspid aortic valve 'wear and tear' (around the 7th or 8th decade of life), atherosclerosis (normal tricuspid valve becomes rigid with age, usually stenosis develops over age 70 and it is rarely severe), congenital bicuspid aortic valve (it is twice as common in men, there is slow increase in stenosis -progressive sclerosis- and as individuals age, calcification of the aortic valve may occur and result in stenosis, this occurs in the 40s and 50s in case of bicuspid valve), prosthetic aortic valve, rheumatic fever (slowly progressive stenosis), subacute bacterial endocarditis.
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Radiation.
Gastroenterologic No underlying causes
Genetic 1/3rd of supravalvular aortic stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).
Hematologic No underlying causes.
Iatrogenic Radiation treatment to the chest.
Infectious Disease Bacterial endocarditis in which the vegetations may favor increase risk of stenosis.
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic Fabry disease, Homozygous type II hypercholesterolemia, Ochronosis, Paget's disease
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes.
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Rheumatic fever (slowly progressive stenosis).
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. ↑ Lugiano, CA. (2013). "Aortic stenosis". JAAPA. 26 (11): 46–7. doi:10.1097/01.JAA.0000436518.69169.8e. PMID 24153092. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 2.2 Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J (2003). "The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis". European Heart Journal. 24 (5): 442–63. PMID 12633546. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)
  3. ↑ Hannoush H, Introne WJ, Chen MY, Lee SJ, O'Brien K, Suwannarat P; et al. (2012). "Aortic stenosis and vascular calcifications in alkaptonuria". Mol Genet Metab. 105 (2): 198–202. doi:10.1016/j.ymgme.2011.10.017. PMC 3276068. PMID 22100375.
  4. ↑ Aronow, WS. (2013). "A review of the pathophysiology, diagnosis, and treatment of aortic valve stenosis in elderly patients". Hosp Pract (1995). 41 (4): 66–77. doi:10.3810/hp.2013.10.1082. PMID 24145591. Unknown parameter |month= ignored (help)
  5. ↑ Strickberger SA, Schulman SP, Hutchins GM. Association of Paget’s disease of bone with calcific aortic valve disease. Am J Med 1987;82:953-6.
  6. ↑ REEVE, R.; ROBINSON, SJ. (1964). "HYPOPLASTIC ANNULUS--AN UNUSUAL TYPE OF AORTIC STENOSIS: A REPORT OF THREE CASES IN CHILDREN". Dis Chest. 45: 99–102. PMID 14114644. Unknown parameter |month= ignored (help)
  7. ↑ Giannakoulas, G.; Mouratoglou, SA.; Kelekis, A.; Hatzimiltiades, S.; Karvounis, H. "Supravalvular aortic stenosis in homozygous familial hypercholesterolemia". Hellenic J Cardiol. 54 (5): 392–3. PMID 24100183.
  8. ↑ Deo, SV.; Burkhart, HM.; Dearani, JA.; Schaff, HV. (2013). "Supravalvar aortic stenosis: current surgical approaches and outcomes". Expert Rev Cardiovasc Ther. 11 (7): 879–90. doi:10.1586/14779072.2013.811967. PMID 23895031. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 VOC=VITIUM ORGANICUM CORDIS, a compendium of the Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008
  10. ↑ Roberts WC, Vowels TJ, Ko JM. Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation). Am J Cardiol. Apr 15 2009;103(8):1139-45.
  11. ↑ http://emedicine.medscape.com/article/150638-overview#aw2aab6b2b3aa

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