Aortic stenosis differential diagnosis

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 must be differentiated from other cardiac or pulmonary causes of dyspnea, weakness, and dizziness. Furthermore, if there is left ventricular outflow tract obstruction, it is critical to identify if the obstruction is subvalvular, valvular or supravalvular or due to Hypertrophic Cardiomyopathy (HOCM).

Differentiating Aortic Stenosis from Pulmonary Causes of Dyspnea

AS can be differentiated from pulmonary causes of dyspnea by the presence of a heart murmur, pulsus parvus and tardus, and signs of heart failure on examination.

Differentiating Aortic Stenosis from Mitral Regurgitation

The murmur of AS is harsh while the murmur of mitral regurgitation is blowing and soft.

Differentiating Valvular Aortic Stenosis from Supravalvular Aortic Stenosis

• 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.
• Congenital anomaly produced by a membranous diaphragm or a fibrous ridge just below the aortic valve

• 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.

• Supravalvular Aortic Stenosis. Uncommon congenital anomaly produced by narrowing of ascending aorta or by fibrous diaphragm with small opening just above aortic valve.
• Hypertrophic Cardiomyopathy (HOCM). Characterized by marked hypertrophy of the LV and involves in particular the interventricular septum.
• Mitral Regurgitation.
• Aortic valve sclerosis. Persons over 65 years of age may have a systolic murmur of AS without obstruction.
• Coronary atherosclerosis (Coronary heart disease) may cause similar symptoms.