Aortic stenosis causes

Aortic Stenosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]

Overview

Aortic stenosis can be categorized under two methods of causation: acquired and congenital. Research regarding the influence of preventative therapies on causation is mixed. More research is needed specifically looking at cholesterol lowering interventions and their role on disease onset.

Etiology of Aortic Stenosis

Valvular Aortic Stenosis:

Acquired

• Rheumatic fever
• Infective endocarditis
• Systemic lupus erythromatosis
• Fabry's disease
• Aortic sclerosis

Congenital

• Bicuspid aortic valve
• Hypoplastic annulus
• Three cuspid valve with commissural fusion

Subvalvular Aortic Stenosis:

• Membranous diaphragm
• Hypertrophic cardiomyopathy

Supravalvular Aortic Stenosis:

• Hypoplasia of aorta
• Hourglass constriction of aorta
• Fibromembranous aortic lesion

Frequency of Underlying Causes of Aortic Stenosis

• According to the Euro Heart Survey on Valvular Heart Disease, the frequency of underlying causes of aortic stenosis was:

1. Calcific degenration- 81.9%
2. Rheumatic fever- 11.2% .
3. Congenital- 5.6%
4. Post-endocarditis- 1.3%

Causes of Aortic Valve Calcification

• Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases). Other causes include:
• Calcification of a congenital bicuspid aortic valve (30-40% of cases of cases of calcification) and
• Acute rheumatic fever (less than 10% of cases of calcification)

Causes of More Rapid AS Progression

• Normal valves have three leaflets (tricuspid), but some valves have two leafs (bicuspid). Typically, aortic stenosis due to calcification of a bicuspid valve appears earlier, in the 40s and 50s, whereas that due to calcification of a normal valve appears later, in the 70s and 80s. Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process .

Complete Differential Diagnosis for the Causes of Aortic Stenosis (Alphabetic Order)

• Age-induced calcification of normal tricuspid aortic valve with degenerative 'wear and tear'.
• Congenital bicuspid aortic valve
• Endocarditis
• Prosthetic Aortic valve
• Radiation treatment to the chest
• Rheumatic fever (slowly progressive stenosis)
• Subvalvular aortic stenosis
• Supravalvular aortic stenosis
• Williams syndrome, autosomal dominant trait is associated with supravalvular aortic stenosis

Complete Differential Diagnosis for the Causes of Aortic Stenosis (Organized by Disease State)

Cardiovascular	Age-induced calcification of normal tricuspid aortic valve 'wear and tear' (around the 7th or 8th decade of life), atherosclerosis (normal tricuspid valve becomes rigid with age, usually stenosis develops over age 70 and it is rarely severe), congenital bicuspid aortic valve (it is twice as common in men, there is slow increase in stenosis -progressive sclerosis- and as individuals age, calcification of the aortic valve may occur and result in stenosis, this occurs in the 40s and 50s in case of bicuspid valve), prosthetic aortic valve, rheumatic fever (slowly progressive stenosis), subacute bacterial endocarditis.
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Radiation.
Gastroenterologic	No underlying causes
Genetic	1/3rd of supravalvular aortic stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).
Hematologic	No underlying causes.
Iatrogenic	Radiation treatment to the chest.
Infectious Disease	Bacterial endocarditis in which the vegetations may favor increase risk of stenosis.
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes.
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	rheumatic fever (slowly progressive stenosis).
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes