Aortic stenosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Última revisión: 5 Dec 2025

Última actualización: 30 Dec 2025

Aortic stenosis is obstruction of blood flow across the aortic valve due to aortic valve fibrosis and calcification. It is usually preceded by aortic sclerosis, often suspected by the presence of an early-peaking, systolic ejection murmur, and confirmed by echocardiography.

Following a decades-long subclinical period, presentation may include fatigue, decreased exercise capacity, exertional dyspnea, exertional chest pain (angina), syncope, and heart failure.

Characteristic murmur is systolic, mid-to-late peaking with a crescendo-decrescendo pattern, and radiates to the carotids.

Doppler echo is essential to the diagnosis and will show a pressure gradient across the stenotic aortic valve.

Treatment of severe aortic stenosis with either a transcatheter or surgical valve prosthesis should be based primarily on symptoms or reduced ventricular systolic function. Earlier intervention may be considered if indicated by results of exercise testing, biomarkers, rapid progression, or the presence of very severe stenosis.

Choice of intervention should be a shared decision-making process, taking account of lifetime risks and benefits associated with the type of approach (transcatheter versus surgical) and type of valve (mechanical vs. bioprosthetic).

Following valve replacement, patients are subject to the complications of prosthetic valves.

Definición

Aortic stenosis (AS) is a degenerative, pathologic narrowing of the aortic valve, leading to symptomatic obstruction of blood flow out of the left ventricle. It is a progressive disease that often follows aortic sclerosis (defined as aortic valve thickening without flow limitation).

Anamnesis y examen

Principales factores de diagnóstico

exertional dyspnea
fatigue
chest pain
exertional syncope
ejection systolic murmur
S2 diminished and single
carotid parvus et tardus

Todos los datos

Otros factores de diagnóstico

paradoxically split S2
Gallavardin phenomenon
bleeding

Todos los datos

Factores de riesgo

age >60 years
congenitally bicuspid aortic valve
rheumatic heart disease
chronic kidney disease
radiation therapy
high low-density lipoprotein (LDL) cholesterol
hyperlipoproteinemia
hypertension
diabetes
elevated lipoprotein(a)
family history
obesity

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

ECG
transthoracic echocardiography (TTE)
chest x-ray

Todos los datos

Pruebas diagnósticas que deben considerarse

cardiac CT
cardiac MRI
CT angiography (CTA)
magnetic resonance angiography
ECG exercise stress testing
dobutamine stress echo
Transesophageal echocardiography (TEE)
cardiac catheterization

Todos los datos

Algoritmo de tratamiento

Inicial

clinically unstable

Agudo

clinically stable: symptomatic

clinically stable: asymptomatic

Colaboradores

Autores

Matthew Czarny, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

Divulgaciones

MC declares their institution receives research funding from Medtronic, Abbott, Edwards Lifesciences, and MedAlliance. MC also receives speaker fees from Medtronic.

Rani Hasan, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

Divulgaciones

RH declares that he has no competing interests.

Agradecimientos

Dr Matthew Czarny and Dr Rani Hasan would like to gratefully acknowledge Dr Girish L. Kalra and Dr Vasilis Babaliaros, previous contributors to this topic.

Divulgaciones

GLK declares that he has no competing interests. VB is a co-investigator in the PARTNER trial, and he has served as a consultant for Edwards Lifesciences and Abbott Vascular.

Revisores por pares

Peter Block, MD

Professor of Medicine

Emory University School of Medicine

Atlanta

Divulgaciones

PB declares that he has no competing interests.

Ghada Mikhail, BSc, MD, FRCP

Consultant Cardiologist and Honorary Senior Lecturer

Imperial College Healthcare NHS Trust

Hammersmith Hospital

London

Divulgaciones

GM has been supported by Edwards Lifesciences (manufacturer of the Edwards Sapien Transcatheter Valve) for attending cardiology conferences. Both Edwards Lifesciences and Medtronic (manufacturer of the CoreValve Transcatheter Valve) are contributing to an educational course on the transcatheter and surgical treatments of aortic and mitral valve disease. Edwards Lifesciences are supporting a research project on transcatheter treatment of aortic valve disease.

Juan M. Sztajzel, MD

Consultant

Cardiology Center

University Hospital Geneva

Geneva

Switzerland

Divulgaciones

JMS declares that he has no competing interests.

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Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Feb 2;143(5):e72-227.Texto completo

National Institute for Health and Care Excellence. Heart valve disease presenting in adults: investigation and management. Nov 2021 [internet publication].Texto completo

Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2025 Nov 21;46(44):4635-736.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Aortic sclerosis
- Ischemic heart disease
- Hypertrophic cardiomyopathy (HCM)
Más Diferenciales
Guías de práctica clínica
- Heart valve disease presenting in adults: investigation and management
- Guideline for the management of patients with valvular heart disease
Más Guías de práctica clínica
Folletos para el paciente
Aortic stenosis
Más Folletos para el paciente
Videos
Aortic stenosis (severe)
How to perform an ECG: animated demonstration
Más vídeos
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Aortic stenosis

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

clinically unstable

clinically stable: symptomatic

clinically stable: asymptomatic

Colaboradores

Autores

Matthew Czarny, MD

Divulgaciones

Rani Hasan, MD

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Peter Block, MD

Divulgaciones

Ghada Mikhail, BSc, MD, FRCP

Divulgaciones

Juan M. Sztajzel, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Videos

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice