This document discusses aortic stenosis, including its causes, symptoms, diagnosis, and treatment. It notes that aortic stenosis can be valvular, subvalvular, or supravalvular and can be caused by rheumatic fever, congenital defects, or age-related calcification. Common symptoms include chest pain, shortness of breath, fatigue, and murmurs. Diagnosis involves echocardiogram, EKG, chest X-ray and cardiac catheterization. Treatment options range from medication to manage symptoms, balloon valvuloplasty, or aortic valve replacement surgery.

1. DR. KALPANA CHETIA
ASSOC. PROF OF MEDICINE
JMCH

2.  Valvular
 Subvalvular
 Supravalvular

3.  Rheumatic – seen in adolescence or
adulthood.
 Congenital – seen in childhood, can be
supravalvular, valvular and subvalvular , may
be associated with bicuspid aortic valve.
 Calcified AS – seen in elderly
 Aortic sclerosis – rheumatic AS is usually
accompanied by either AR or MV disease.

8.  chest pain as the heart strains to pump
enough blood through the compromised
valve
 feeling tired after exertion, as when you
exercise or move
 feeling short of breath, especially after
exertion
 heart palpitations, or abnormal heartbeats
 a heart murmur, which is an abnormal
swooshing sound produced by the heart as it
beats

9.  Most patients with aortic stenosis develop one or
more of these three classic symptoms: shortness
of breath, loss of consciousness, and chest pain.
Thickening of the walls of the left ventricle
causes the ventricle to become stiff and unable
to relax between contractions. When this
happens, the pressure in the left ventricle rises
and blood can "back up" into the lungs,
interfering with normal absorption of oxygen
from the lungs into the bloodstream. This may
cause shortness of breath, which worsens as the
left ventricle becomes increasingly impaired.

10.  Patients with aortic stenosis may also
experience chest pain, pressure, or
discomfort (called angina or angina pectoris),
caused by an insufficient supply of oxygen to
the heart. As the left ventricle thickens and
works harder to expel blood through the
stenotic aortic valve, its demand for oxygen
increases.

11.  Low bp
 Low pulse pressure
 Low volume slow rising sustained pulse
 Systolic thrill at aortic area
 Systolic murmur conducted to carotids
 Cardiomegaly
 Heaving apex beat
 Basal crepitations

12.  Electrocardiogram – LVH with strain pattern ,
LBBB, complete heart block .
 Chest x-ray – rounded apex, cardiomegaly ,
post stenotic dilatation of AA, calcified aortic
valve.
 2D Echo- LVH, calcified aortic valve, gradiat
measurement to assess severity.
 Cardiac cathetarisation- to estimate gradient
across aortic valve and detect AR if present.
 Coronary angiography – to detect CAD before
surgery.

13.  LVF rapidly progressive
 Right ventricular failure – end stage indicates
poor prognosis.
 Sudden death due to arrhythmias ( ventricular
fibrillation )
 Complete heart block
 Infective endocarditis
 Hemolysis
 Aortic dissection .

14.  Treatment of LVF
 Rheumatic fever and IE prophylexis
 Beta-blockers to reduce HR, improve
coronary artery blood flow in patients with
IHD.
 Statins for AS due to aortic sclerosis

15.  BALLOON AORTIC COMMISSUROTOMY OR
OPEN HEART AORTIC VALVE
COMMISSUROTOMY
 If associated with AI aortic valve replacement
 If associated with MS both aortic valve and
MV should be operated simultaneously
 Balloon valvotomy – indications are mainly in
children and young adults with congenital AS,
in elderly unfit for surgery, as a temporary
measure in unstablepatients .

16.  Murmur- longer the murmur and later the
peaking of murmur , more severe the AS.
 A2 followed by P2 ( MILD AS) , delayed A2 –
merging with P2 single S2 ( moderate AS) , A2
following P2 –reversed splitting ( severe AS )
 S4 audible and absent A2 – severe AS.
 S3 audible – severe systolic dysfunction

17.  Mild- less than 30 mm of Hg .
 Moderate – 30 -50 mm of Hg.
 Severe – greater than 50 mm of Hg .

18.  Normal aortic valve area 3-4 cm2 / m2 body
surface area .
 Mild AS- 1-2 cm2 /m2 body surface area.
 Severe AS less than 0.75 cm2/m2 body
surface area
 Critical AS – less than 0.5 cm2 /m2 body
surface area.

19.  Functional in severe AR.
 Sclerotic aortic valve
 Coarctation of aorta
 VSD murmur
 MR murmur transmitted to base of heart
 Syphilitic aortitis
 Supravalvular AS ,
 Subvalvular intrinsic hypertrophic AS .