Diagnosis

Aortic stenosis

Etiology

Cause [6rv]

• Degenerative calcific disease (high-income countries)

• Congenital stenosis

• Bicuspid aortic valve

• Infections: acute rheumatic fever or infective endocarditis (low-income countries)

• Other diseases: systemic lupus erythematosus, ochronosis, irradiation, lipoproteinemia, Fabry disease

Pathophysiology [6rv]

• Stenosis of the Aortic valves -> left ventricular outflow obstruction -> left ventricular hypertrophy and decreased LV compliance -> Heart failure

Complications [6rv]

• Heart failure

• Pulmonary hypertension

• Infective endocarditis

• Cerebral or systemic emboli

• Sudden death

Epidemiology

Prevalence per 100.000 [hcp][ae4][f65][gqc][ups]

Incidence per 100.000 [hcp][ae4][f65][gqc][ups]

Approach

• Blood test: Cardiac biomarkers, B-type natriuretic peptide

• ECG

• Chest X-ray

• Echocardiography

• Coronary angiography

Treatment

1. Medical treatment of acute heart failure due to aortic stenosis: [fci][6rv]

   • telemetry, oxygen, nitrates, noninvasive or invasive ventilatory support

2. Mild and Moderate aortic stenosis (asymptomatic) -> medical treatment

   • Digitalis, diuretics, ACE inhibitors, vasodilators

3. Severe low/high-gradient aortic stenosis (symptomatic) -> Aortic valve replacement

   • Open aortic valve replacement or percutaneous transcatheter valve replacement

   • Bioprosthetic and mechanical valves: determined by the anticipated longevity of the patient and his/her ability to tolerate anticoagulation

Differential diagnoses

Acute interstitial pneumonia, Acute respiratory distress syndrome, Aortic coarctation, Aortic regurgitation, Cardiomyopathy, COPD, Mitral regurgitation, Mitral stenosis, Myocardial infarction, Pneumonia, Pulmonary embolism, Pulmonary fibrosis, Tricuspid stenosis