Summary
Definition
History and exam
Key diagnostic factors
- exertional dyspnea
- fatigue
- chest pain
- exertional syncope
- ejection systolic murmur
- S2 diminished and single
- carotid parvus et tardus
Other diagnostic factors
- paradoxically split S2
- Gallavardin phenomenon
- bleeding
Risk factors
- age >60 years
- congenitally bicuspid aortic valve
- rheumatic heart disease
- chronic kidney disease
- radiation therapy
- high low-density lipoprotein (LDL)-cholesterol
- hyperlipoproteinemia
- hypertension
- elevated lipoprotein(a)
Diagnostic investigations
1st investigations to order
- transthoracic echocardiogram (including Doppler)
- ECG
- chest x-ray
Investigations to consider
- cardiac MRI
- cardiac catheterization
- ECG exercise stress testing
- dobutamine stress echo
Treatment algorithm
clinically unstable
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.
Differentials
- Aortic sclerosis
- Ischemic heart disease
- Hypertrophic cardiomyopathy (HCM)
More DifferentialsGuidelines
- Guidelines on the management of valvular heart disease
- 2020 AHA/ACC guideline for the management of patients with valvular heart disease
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