Aortic stenosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2]; Abdul-Rahman Arabi, M.D. [3]; Keri Shafer, M.D. [4]; Priyamvada Singh, MBBS [[5]]

Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]

Overview

When diagnosing aortic stenosis, it is important to rule out underlying causes. Conditions associated with aortic stenosis include fixed subvalvular obstruction and dynamic subaortic obstruction. Both conditions have unique characteristics to that differentiate from aortic stenosis symptomology.

Differential diagnosis

• Fixed subvalvular obstruction

Symptomology associated with fixed subvalvular obstruction includes:

Presence of subaortic membrane

May be difficult to visualise in 2D echocardiography

Presents in early adulthood

Valve is not stenotic, but doppler shows increased gradient.

Can be diagnosed with careful search using pulse wave doppler and colour flow mapping

• Dynamic subaortic obstruction

Symptomology associated with dynamic subaortic obstruction includes:

Occurs with hypertrophic cardiomyopathy(HOCM)

Other features of HCM

Late peaking, triangular CW doppler

Changes with provocative measures