Aortic Stenosis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
It is the most common of all valvular abnormalities. Normal aortic valve area = 3-4 cm2
- Mild AS - valve area 1.5 to 3 cm²
- Moderate AS - valve area 1.0 to 1.5 cm²
- Severe AS - valve area < 1.0 cm²
- Critical AS - valve area < 0.5 cm
Clinical presentation
Aortic Stenosis clinically present with symptoms Of angina (most common) , syncope , CHF ( most serious ) , hemolytic anemia and sudden death.
On examination
There is Slow - rising pulse with narrow pulse pressure and crescendo decrescendo ejection systolic murmur at right 2nd inter - costal space. The murmur radiates to carotids, is increased with passive leg raise (increased pre - load) and decrease with standing and Valsalva (decreased pre - load)
Investigations
- ECG: P - mitral, LVH with strain pattern; LAD (left anterior hemi block), LBBB or complete AV block.
- CXR: LVH; calcified aortic valve, Post - stenotic dilatation of ascending aorta.
- Echocardiography: Doppler echo can estimate the gradient across valves. Severe stenosis if peak gradient 2 50mmHg and valve area < 1cm².
Management
- Asymptomatic patients with severe aortic stenosis (aortic valve area less than 1.0 cm ' ) should generally undergo intervention according to the following guidelines
- They are undergoing other cardiac surgery (i.e., CABG),
- There is evidence for a reduced LVEF (less than 50 %)
- When there are severe valvular calcium
- Symptomatic patients - Valve replacement
- If patient not fit for surgery Percutaneous valve replacement.