Aortic stenosis differential diagnosis

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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], Mohammed A. Sbeih, M.D. [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]

Overview

When diagnosing aortic stenosis, it is important to rule out underlying causes. Conditions associated with aortic stenosis include fixed subvalvular obstruction and dynamic subaortic obstruction. Both conditions have unique characteristics that differentiate from aortic stenosis symptomology. Aortic stenosis must be clinically differentiated from other cardiac or pulmonary conditions with similar symptoms such as Hypertrophic Cardiomyopathy (HOCM) or Mitral Regurgitation.

Differential Diagnosis

• 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.