Aortic stenosis symptoms: Difference between revisions

	Aortic Stenosis Microchapters
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Revision as of 18:33, 25 July 2011

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

Aortic stenosis can cause many symptoms such as dizziness, syncope, angina, and congestive heart failure. Research has speculated that some conditions may be caused an aortic stenosis, these include Heyde's syndrome and von Willebrand factor.

Symptoms

When symptomatic, aortic stenosis can cause:

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

Congestive Heart Failure

Congestive heart failure (CHF) carries a grave prognosis in patients with AS. Patients with CHF that is attributed to AS have a 2 year mortality rate of 50%, if the aortic valve is not replaced.

CHF in the setting of AS is due to a combination of systolic dysfunction (a decrease in the ejection fraction) and diastolic dysfunction (elevated filling pressure of the LV).

Syncope

Angina

Associated Symptoms

In Heyde's syndrome, aortic stenosis is associated with angiodysplasia of the colon. Recent research has shown that the stenosis causes a form of von Willebrand disease by breaking down its associated coagulation factor (factor VIII-associated antigen, also called von Willebrand factor), due to increased turbulence around the stenosed valve.

References

Template:WH Template:WS

@@ Line 5: / Line 5: @@
 '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]]
+==Overview==
+Aortic stenosis can cause many symptoms such as dizziness, [[syncope]], [[angina]], and [[congestive heart failure]]. Research has speculated that some conditions may be caused an aortic stenosis, these include [[Heyde's syndrome]] and [[von Willebrand factor]].
 ==Symptoms==
@@ Line 19: / Line 22: @@
 CHF in the setting of AS is due to a combination of systolic dysfunction (a decrease in the [[ejection fraction]]) and [[diastolic dysfunction]] (elevated filling pressure of the LV).
-===Syncope===
+===[[Aortic stensois symptoms syncope|Syncope]]===
-[[Fainting|Syncope]] in the setting of heart failure increases the risk of death.  In patients with syncope, the 3 year mortality rate is 50%, if the aortic valve is not replaced.
-It is unclear why aortic stenosis causes [[syncope]]. One popular theory is that severe AS produces a nearly fixed [[cardiac output]].  When the patient exercises, their [[peripheral vascular resistance]] will decrease as the blood vesels of the [[skeletal muscles]] dilate to allow the muscles to receive more blood to allow them to do more work.  This decrease in peripheral vascular resistance is normally compensated for by an increase in the cardiac output. Since patients with severe AS cannot increase their cardiac output, the blood pressure falls and the patient will syncopize due to decreased blood perfusion to the [[brain]].
-A second theory as to why syncope may occur in AS is that during exercise, the high pressures generated in the hypertrophied LV cause a vasodepressor response, which causes a secondary peripheral [[vasodilation]] which in turn causes decreased blood flow to the [[brain]]. Indeed, in aortic stenosis, because of the fixed obstruction to bloodflow out from the heart, it may be impossible for the heart to increase its output to offset peripheral vasodilation.
-A third mechanism may sometimes be operative. Due to the hypertrophy of the [[left ventricle]] in aortic stenosis, including the consequent inability of the [[coronary arteries]] to adequately supply blood to the [[myocardium]] (see "Angina" below), [[arrhythmias]] may develop. These can lead to [[syncope]].
-Finally, in calcific aortic stenosis at least, the calcification in and around the aortic valve can progress and extend to involve the [[electrical conduction system of the heart]]. If that occurs, the result may be [[heart block]] - a potentially lethal condition of which syncope may be a symptom.
-===Angina===
-[[Angina pectoris|Angina]] in the setting of heart failure also increases the risk of death.  In patients with angina, the 5 year mortality rate is 50%, if the aortic valve is not replaced.
-Angina in the setting of AS is secondary to the [[left ventricular hypertrophy]] (LVH) that is caused by the constant production of increased pressure required to overcome the pressure gradient caused by the AS.  While the [[myocardium]] (i.e. heart muscle) of the LV gets thicker, the arteries that supply the muscle do not get significantly longer or bigger, so the muscle may become ischemic (i.e. doesn't receive an adequate blood supply).  The [[ischemia]] may first be evident during exercise, when the heart muscle requires increased blood supply to compensate for the increased workload.  The individual may complain of exertional angina.  At this stage, a [[stress test]] with imaging may be suggestive of ischemia.
-Eventually, however, the muscle will require more blood supply at rest than can be supplied by the coronary artery branches.  At this point there may be signs of ''ventricular strain pattern'' on the [[EKG]], suggesting subendocardial ischemia.  The subendocardium is the region that becomes ischemic because it is the most distant from the epicardial coronary arteries.
+===[[Aortic stenosis symptoms angina|Angina]]===
 ===Associated Symptoms===
@@ Line 55: / Line 44: @@
 [[pl:Stenoza Aortalnej]]
 [[pt:Estenose aórtica]]
-[[ro:Stenoza Aortică]]
+[[ro:Stenoza Aortic?]]
-[[tr:Aort darlığı]]
+[[tr:Aort darl???]]
 {{WH}}
 {{WS}}