Aortic stenosis overview

Jump to navigation Jump to search

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

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic stenosis overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic stenosis overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic stenosis overview

CDC on Aortic stenosis overview

Aortic stenosis overview in the news

Blogs on Aortic stenosis overview

Directions to Hospitals Treating Aortic stenosis overview

Risk calculators and risk factors for Aortic stenosis overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2]; Abdul-Rahman Arabi, M.D. [3]; Keri Shafer, M.D. [4]; Priyamvada Singh, MBBS [5]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [6]

Overview

The aortic valve controls the direction of blood flow from the left ventricle to the aorta. When functioning appropriately, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis, often abbreviated as AS.

Pathophysiology

When the aortic valve becomes stenosed, it can result in the formation of a pressure gradient between the left ventricle (LV) and the aorta [1]. The more constricted the valve, the higher the gradient between the LV and the aorta.

In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased afterload caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the myocardium (muscle) of the LV undergoes hypertrophy (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened.

Clinical presentation

When symptomatic, aortic stenosis can cause:

Patients exhibiting multiple symptoms often experience a worsened prognosis and overall decrement in quality of life.

Diagnostic tests

After the history and physical examination, some tests may be done to confirm the diagnosis of aortic stenosis. Tests include:

  • Echocardiogram (heart ultrasound) is the best non-invasive test to evaluate the aortic valve anatomy and function and to diagnose aortic stenosis.
  • Electrocardiogram (ECG) manifestations of left ventricular hypertrophy (LVH) are common in aortic stenosis.
  • Chest x-ray can show enlarged left ventricle if there is severe aortic stenosis for a long time.
  • Magnetic resonance imaging can be helpful as a diagnostic tool if the echocardiographic findings are inconclusive.
  • Computed tomography also can be helpful as a diagnostic tool if echocardiographic findings are inconclusive.

Treatment

References

  1. Lilly LS (editor) (2003). Pathophysiology of Heart Disease (3rd ed. ed.). Lippincott Williams & Wilkins. ISBN 0-7817-4027-4.

Template:WH Template:WS