Aortic Stenosis
What is the most common valvular heart disease in the developed world?
Aortic stenosis
What is Aortic Sclerosis?
Aortic valve sclerosis is the thickening and calcification without a significant pressure gradient.
What is the anterograde velocity across the valve in Aortic Stenosis?
The anterograde velocity across the valve must be at least 2 m/sec, whereas aortic valve sclerosis is the thickening and calcification without a significant pressure gradient.
What is the ‘Rate of progression’ from aortic sclerosis to aortic stenosis
Rate of progression from aortic sclerosis to stenosis is 1.8% to 1.9%
per year
Which of the following has poor prognosis on AS?
Poor prognosis and are established Class I indications for AVR
Severe AS that causes symptoms or left ventricular ejection fraction (LVEF) <50%
What are the common causes of AS?
Etiologies –
- Congenital (bicuspid/unicuspid)
- Calcific
- Rheumatic disease.
What is the prognosis of AS?
Aortic Stenosis – Symptoms such as exertional dyspnea or fatigue gradually develop after a long asymptomatic latent period of about 10 to 20 years.
Asymptomatic phase – Survival is excellent
Mortality is more than 90% within a few years after the onset of symptoms.
In developing countries, aortic valvular stenosis or regurgitation are typically caused by rheumatic heart disease or infective endocarditis. On the other hand, in industrialised countries, valvular diseases are mostly degenerative
Most common cause of aortic stenosis in patients less than the age of 70 years in developed countries.
Bicuspid aortic valve is the most common cause of aortic stenosis in patients less than the age of 70 years in developed countries
Most common cause of aortic stenosis in patients in developing countries.
Rheumatic valve disease is the most common cause of aortic stenosis in developing countries.
What are the causes of aortic stenosis?
| Causes of aortic stenosis | |
| Rheumatic disease. | Most common cause of aortic stenosis in patients in developing countries. |
| Congenital (bicuspid/unicuspid) | Most common cause of aortic stenosis in patients less than the age of 70 years in developed countries. |
| Calcific | |
| Other causes | |
| Calcification of the tri-leaflet valve | |
| Alkaptonuria | Alkaptonuria is a rare, inherited metabolic disorder where the body cannot properly break down the amino acid tyrosine, leading to the buildup of homogentisic acid Ochronotic pigment deposition in the aortic valve can lead to progressive dystrophic calcification and fibrosis, ultimately causing the valve to thicken and stiffen, leading to stenosis. |
| Systemic lupus erythematosus | |
| Irradiation | |
| Homozygous type II lipoproteinemia | |
| Fabry disease | Metabolic disease |
| End-stage renal disease | Mineral metabolism disturbances |
What is the cause of angina in Aortic Stenosis?
Angina results from the combination of the Increased demand and Decreased supply.
- Need for increased oxygen in hypertrophied myocardium
- Reduction of oxygen delivery secondary to the excessive compression of coronary vessels.
What is the cause of Syncope in Aortic Stenosis?
Syncope from aortic valve stenosis is usually exertional – systemic vasodilation -Decrease in cerebral perfusion occurring during exertion
| Aortic valve stenosis – Exertion – Systemic vasodilation – Arterial pressure declines – Decrease in cerebral perfusion – Syncope |
| In Aortic Stenosis – Syncope is caused by | |
| 1 | Decrease in cerebral perfusion occurring during exertion when the arterial pressure declines due to systemic vasodilation |
| 2 | Inadequate increase in cardiac output related to Aortic stenosis. |
| 3 | Malfunction of the baroreceptor mechanism in severe aortic stenosis. |
| “Dresden china” appearance of pallor |
| “Dresden china” appearance of pallor is often used to describe the pale, almost porcelain-like complexion, often with a slight bluish tinge, seen in individuals with severe aortic stenosis |
“Dresden china” appearance of pallor
“Dresden china” appearance of pallor is often used to describe the pale, almost porcelain-like complexion, often with a slight bluish tinge, seen in individuals with severe aortic stenosis
“Dresden china” appearance of pallor is a specific sign of reduced blood flow, where the skin takes on a pale, almost bluish, or ashen color
| Symptoms related to aortic stenosis | if the aortic valve is not replaced | |
| Angina | If angina present – 5-year mortality rate is 50% if the aortic valve is not replaced | |
| Syncope | If Syncope present – three-year mortality rate is 50% if the aortic valve is not replaced | |
| Congestive heart failure | If Congestive heart failure present – 2-year mortality rate of 50% if the aortic valve is not replaced |
