Aortic stenosis overview

Aortic Stenosis Microchapters
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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

The aortic valve controls the direction of blood flow from the left ventricle to the aorta. When functioning appropriately, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis, often abbreviated as AS.

Pathophysiology

When the aortic valve becomes stenosed, it can result in the formation of a pressure gradient between the left ventricle (LV) and the aorta . The more constricted the valve, the higher the gradient between the LV and the aorta.

In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased afterload caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the myocardium (muscle) of the LV undergoes hypertrophy (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened.

Clinical presentation

When symptomatic, aortic stenosis can cause:

• Dizziness.
• Syncope.
• Angina.
• Congestive heart failure.

Patients exhibiting multiple symptoms often experience a worsened prognosis and overall decrement in quality of life.

Diagnostic tests

After the history and physical examination, some tests may be done to confirm the diagnosis of aortic stenosis. Tests include:

• Electrocardiogram: ECG manifestations of left ventricular hypertrophy (LVH) are common in aortic stenosis.
• Chest x-ray can show enlarged left ventricle if there is severe aortic stenosis for a long time.
• Magnetic resonance imaging can be helpful as a diagnostic tool if the echocardiographic findings are inconclusive.
• Computed tomography also can be helpful as a diagnostic tool if echocardiographic findings are inconclusive.