Aortic Stenosis

Introduction

Aortic stenosis refers to abnormal narrowing of the aortic valve. It is one of the most common valve lesions.

Murmur

Sound: Ejection systolic murmur

Loudest region: Aortic area (Right sternal border at 2nd intercostal space)

Radiation: Carotid artery

Accentuation: Expiration

Ejection systolic murmur. Source: University of Michigan Murmur library

Causes

• Senile valve calcification
• Congenital heart defects e.g. bicuspid
• Rheumatic fever
• Infective endocarditis

Differential diagnosis

• Aortic sclerosis – does not radiate to carotid arteries
• Hypertrophic obstructive cardiomyopathy (HOCM) – accentuated by Valsalva manoeuvre
• Pulmonary stenosis
• Atrial septal defect

Investigations

• Echocardiogram
• ECG: may show left ventricular hypertrophy
• Chest x-ray
• Blood cultures, if considering infective endocarditis

Management

Asymptomatic patients should be managed conservatively with regular echocardiogram follow-up.

The following patients should be treated surgically:

• Symptomatic patients
• Echocardiographic evidence of severe aortic stenosis:
  • <1cm² aortic valve area
  • Pressure gradient >40 mmHg across the aortic valve

Complications

• Left ventricular hypertrophy and heart failure
• Arrhythmias
• Syncope
• Sudden death
• Infective endocarditis