Ao

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Aortic Stenosis
Heart_diagram-en.svg
Synonyms N/A
Pronounce N/A
Specialty N/A
Symptoms Chest pain, shortness of breath, fainting
Complications Heart failure, arrhythmias
Onset Gradual
Duration Long-term
Types N/A
Causes Age-related calcification, congenital heart defects
Risks N/A
Diagnosis Echocardiogram, cardiac catheterization
Differential diagnosis N/A
Prevention N/A
Treatment Valve replacement, medications
Medication N/A
Prognosis N/A
Frequency Common in older adults
Deaths N/A


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 condition can lead to significant cardiovascular complications if left untreated.

Pathophysiology

Aortic stenosis occurs when the aortic valve becomes narrowed, usually due to calcification, which is the accumulation of calcium deposits on the valve leaflets. This calcification can be age-related or due to congenital defects such as a bicuspid aortic valve. The narrowing of the valve opening increases the resistance against which the left ventricle must pump, leading to increased ventricular hypertrophy and eventually heart failure if untreated.

Causes

The primary causes of aortic stenosis include:

  • Age-related calcific aortic stenosis: This is the most common cause in adults over 65 years of age. It results from progressive calcification and fibrosis of the valve leaflets.
  • Congenital bicuspid aortic valve: A congenital condition where the aortic valve has only two leaflets instead of three, leading to early calcification and stenosis.
  • Rheumatic heart disease: Although less common in developed countries, rheumatic fever can cause scarring of the aortic valve, leading to stenosis.

Symptoms

Patients with aortic stenosis may experience a range of symptoms, including:

  • Chest pain: Due to increased myocardial oxygen demand and reduced coronary perfusion.
  • Shortness of breath: Resulting from increased pulmonary venous pressure.
  • Fainting: Often occurs during exertion due to reduced cerebral perfusion.
  • Fatigue: Due to reduced cardiac output.

Diagnosis

The diagnosis of aortic stenosis is typically confirmed through:

  • Echocardiography: The primary diagnostic tool, which can assess the severity of stenosis and left ventricular function.
  • Cardiac catheterization: Used to measure the pressure gradient across the aortic valve and confirm the diagnosis in certain cases.
  • ECG: May show signs of left ventricular hypertrophy.

Treatment

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

  • Aortic valve replacement: The definitive treatment for severe aortic stenosis. This can be done surgically or via transcatheter aortic valve replacement (TAVR) in patients who are high-risk surgical candidates.
  • Medications: While they do not treat the stenosis itself, medications such as diuretics and beta-blockers can help manage symptoms.
  • Lifestyle modifications: Patients are advised to avoid strenuous activities and manage risk factors such as hypertension and hyperlipidemia.

Prognosis

The prognosis for patients with aortic stenosis varies depending on the severity of the condition and the treatment received. Without treatment, severe aortic stenosis has a poor prognosis, with a high risk of heart failure and sudden cardiac death. However, with timely valve replacement, most patients can expect a significant improvement in symptoms and quality of life.

See also



Cardiovascular disease A-Z

Most common cardiac diseases

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Contributors: Prab R. Tumpati, MD