Aortic stenosis causes: Difference between revisions
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====Causes of More Rapid AS Progression==== | ====Causes of More Rapid AS Progression==== | ||
*Normal valves have three leaflets (tricuspid), but some valves have two leafs (bicuspid). | *Normal valves have three leaflets (tricuspid), but some valves have two leafs (bicuspid). Aortic stenosis due to calcification of a [[bicuspid valve]] typically becomes symptomatic 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 <ref name=uas/>. | ||
==Cause of Aortic Stenosis as a Function of Age== | ==Cause of Aortic Stenosis as a Function of Age== | ||
Revision as of 18:23, 16 October 2012
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis causes On the Web |
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American Roentgen Ray Society Images of Aortic stenosis causes |
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Risk calculators and risk factors for Aortic stenosis causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3] Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Aortic stenosis can be classified as either acquired or congenital.
Etiology of Aortic Stenosis
Valvular Aortic Stenosis:
Acquired [1]
- Calcific degeneration
- Rheumatic fever
- Infective endocarditis
- Systemic lupus erythromatosis
- Fabry's disease
- Aortic sclerosis
Congenital [1]
- 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[1] on valvular heart disease, the frequencies of the different underlying causes of aortic stenosis were the following:
- Calcific degenration- 81.9%
- Rheumatic fever- 11.2% [2].
- Congenital- 5.6%
- 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)
- 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). Aortic stenosis due to calcification of a bicuspid valve typically becomes symptomatic 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 [2].
Cause of Aortic Stenosis as a Function of Age
The cause of aortic stenosis will vary with age [3][4].
Under Age 70
- Bicuspid aortic valve: 50%
- Postinflammatory: 25%
- Degenerative calcific: 18%
- Unicommissural 3%
- Hypoplastic: 2%
- Indeterminant:2%
Over Age 70
- Degenerative calcific: 48%
- Bicuspid: 27%
- Postinflammatory: 23%
- Hypoplastic: 2%
Complete Differential Diagnosis for the Causes of Aortic Stenosis
Organized by Organ System
| 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 | Fabry disease, Homozygous type II hypercholesterolemia, Ochronosis, Paget's disease |
| 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 |
Causes in Alphabetic Order
- Age-induced calcification of normal tricuspid aortic valve with degenerative 'wear and tear'.
- Congenital bicuspid aortic valve
- Endocarditis
- Fabry disease
- Fryns-van den Berghe syndrome
- Homozygous type II hypercholesterolemia
- Ochronosis
- Paget disease
- Prosthetic aortic valve
- Radiation treatment to the chest
- Rheumatic fever (slowly progressive stenosis)
- Singleton-Merten syndrome
- Subvalvular aortic stenosis
- Supravalvular aortic stenosis
- Williams syndrome, autosomal dominant trait is associated with supravalvular aortic stenosis
References
- ↑ 1.0 1.1 1.2 Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J (2003). "The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis". European Heart Journal. 24 (5): 442–63. PMID 12633546. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 VOC=VITIUM ORGANICUM CORDIS, a compendium of the Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008
- ↑ Roberts WC, Vowels TJ, Ko JM. Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation). Am J Cardiol. Apr 15 2009;103(8):1139-45.
- ↑ http://emedicine.medscape.com/article/150638-overview#aw2aab6b2b3aa