Alerts and Notices
SynopsisAortic stenosis (AS) is the narrowing of left ventricular outflow through the aortic valve. It is the most prevalent cause of ventricular outflow obstruction, and it is increasing in prevalence as the population ages and life expectancy increases. While patients are generally asymptomatic in the presence of mild outflow obstruction, exertional dyspnea, chest discomfort, fatigue, dizziness, and syncope develop as the degree of obstruction progresses.
Contributing etiologies include calcification of the aortic valve cusps (most common in the elderly population), congenital abnormalities (ie, bicuspid aortic valve), rheumatic fever, chest radiotherapy, endocarditis, and alkaptonuria. Potential complications include heart failure, cardiac arrhythmias, infectious endocarditis, pulmonary hypertension, excessive bleeding, stroke, and other embolic events.
There is no known medical therapy available to delay progression of AS. Patients should be monitored carefully with serial clinical evaluations and echocardiography in order to determine if and when aortic valve replacement is needed, which may be performed by surgical or transcatheter aortic valve replacement (TAVR). Prolonged or intense physical activity and competitive sports should be avoided in patients with severe AS.
I06.0 – Rheumatic aortic stenosis
I35.0 – Nonrheumatic aortic (valve) stenosis
60573004 – Aortic valve stenosis
Differential Diagnosis & Pitfalls
- Congestive heart failure (systolic)
- Heart failure with preserved ejection fraction
- Supravalvular aortic outflow obstruction
- Obstructive hypertrophic cardiomyopathy
- Other valvular disorders – mitral valve stenosis or mitral valve insufficiency, aortic insufficiency
- Endocarditis – see acute bacterial endocarditis
- Acute coronary syndrome