Aortic stenosis

Last reviewed: 6 Sep 2022
Last updated: 16 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • exertional dyspnoea
  • fatigue
  • chest pain
  • exertional syncope
  • ejection systolic murmur
  • S2 diminished and single
  • carotid parvus et tardus
More key diagnostic factors

Other diagnostic factors

  • paradoxically split S2
  • Gallavardin's phenomenon
  • bleeding
Other diagnostic factors

Risk factors

  • age >60 years
  • congenitally bicuspid aortic valve
  • rheumatic heart disease
  • chronic kidney disease
  • radiotherapy
  • high low-density lipoprotein (LDL) cholesterol
  • hyperlipoproteinaemia
  • hypertension
  • elevated lipoprotein(a)
More risk factors

Diagnostic investigations

1st investigations to order

  • transthoracic echocardiogram (including Doppler)
  • ECG
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • cardiac MRI
  • cardiac CT
  • cardiac catheterisation
  • ECG exercise stress testing
  • dobutamine stress echo
More investigations to consider

Treatment algorithm

INITIAL

clinically unstable

ACUTE

clinically stable: symptomatic

clinically stable: asymptomatic

Contributors

Authors

Matthew Czarny, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

MZ is a non-funded site co-investigator for the Medtronic trial of transcatheter aortic valve replacement (TAVR) in low surgical risk patients.

Rani Hasan, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

RH declares that he has no competing interests.

Acknowledgements

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

Disclosures

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.

Peer reviewers

Peter Block, MD

Professor of Medicine

Emory University School of Medicine

Atlanta

GA

Disclosures

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

UK

Disclosures

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

Disclosures

JMS declares that he has no competing interests.

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