Aortic stenosis

Blausen 0040 AorticStenosis

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Cardiovascular calcification - Sergio Bertazzo.

Phonocardiograms from normal and abnormal heart sounds

Aortic Stenosis - Hemodynamic Pressure Tracing

Aortic stenosis (AS) is a condition characterized by the narrowing of the aortic valve opening, which restricts blood flow from the left ventricle to the aorta and onward to the rest of the body. This narrowing can cause the heart to work harder to pump blood, leading to various symptoms and complications. Aortic stenosis is the most common valvular heart disease in developed countries and primarily affects older adults.

Causes

Aortic stenosis can be caused by several factors, including:

• Congenital heart defect: Some individuals are born with an aortic valve that has only two cusps (bicuspid aortic valve) instead of the normal three, which can lead to stenosis.
• Calcific aortic stenosis: The most common cause in the elderly, where calcium deposits on the aortic valve leaflets lead to stiffening and narrowing of the valve.
• Rheumatic fever: A complication of streptococcal infections that can cause scarring of the aortic valve, leading to stenosis later in life.

Symptoms

Symptoms of aortic stenosis may include:

• Dyspnea (difficulty breathing)
• Angina (chest pain)
• Syncope (fainting spells)
• Heart failure symptoms, such as fatigue and swelling of the legs

Many individuals with aortic stenosis may not experience symptoms until the condition becomes severe.

Diagnosis

Diagnosis of aortic stenosis involves a combination of medical history, physical examination, and diagnostic tests, including:

• Echocardiogram, which is the primary tool for diagnosing aortic stenosis and assessing its severity.
• Electrocardiogram (ECG or EKG), which can show signs of left ventricular hypertrophy or other alterations.
• Cardiac catheterization, which may be used to assess the severity of stenosis and plan for potential interventions.

Treatment

Treatment for aortic stenosis depends on the severity of the condition and the presence of symptoms:

• Observation: Patients with mild stenosis and no symptoms may simply require regular monitoring.
• Medication: While medications cannot reverse aortic stenosis, they may be used to manage symptoms.
• Surgical valve replacement: For severe stenosis, surgical replacement of the aortic valve is often necessary. Options include mechanical valves, bioprosthetic valves, and the less invasive transcatheter aortic valve replacement (TAVR).

Prognosis

The prognosis for individuals with aortic stenosis varies. Without treatment, symptomatic severe aortic stenosis has a poor prognosis, but valve replacement surgery can significantly improve outcomes and quality of life.

Epidemiology

Aortic stenosis primarily affects older adults, with the prevalence increasing with age. It is estimated that approximately 2-7% of the population over the age of 65 has some degree of aortic stenosis.