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Aortic stenosis: Difference between revisions
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<section begin="radiology" />'''Aortic stenosis''' (AS) refers to narrowing of the aortic valve, resulting in increased pressure load on the left ventricle. AS is mostly a disorder of the elderly (>70 years) men, and it’s the most common [[Valvular heart disease|valvular disease]]. Some also have some degree of [[aortic regurgitation]].<section end="radiology" /> | <section begin="radiology" />'''Aortic stenosis''' (AS) refers to narrowing of the aortic valve, resulting in increased pressure load on the left ventricle. AS is mostly a disorder of the elderly (>70 years) men, and it’s the most common [[Valvular heart disease|valvular disease]]. Some also have some degree of [[aortic regurgitation]].<section end="radiology" /> | ||
Most cases are discovered incidentally when a systolic murmur is heard. The condition is asymptomatic for years or decades before symptoms develop. | |||
== Etiology == | == Etiology == | ||
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In developing countries, [[rheumatic fever]] remains a significant cause. | In developing countries, [[rheumatic fever]] remains a significant cause. | ||
== Pathophysiology == | |||
A stenotic aortic valve means an increased obstruction of the left ventricle's outflow. Initially the left ventricle can overcome the increased resistance, but this causes concentric hypertrophy and remodelling of the left ventricle. The compliance of the left ventricle is reduced. This may lead to diastolic heart failure ([[heart failure with preserved ejection fraction]], HFpEF). | |||
Because of the reducing compliance of the left ventricle, the ventricle is more dependent on the left atrial contraction for filling than in a healthy heart. If atrial fibrillation should occur, this atrial contraction is lost, worsening the patients symptoms. | |||
== Clinical features == | == Clinical features == | ||
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<section begin="radiology" /> | <section begin="radiology" /> | ||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
[[Echocardiography]] allows for assessment of the narrowing of the aortic valve opening area and the pressure gradient and velocity across the valve, which is increased in case of stenosis. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]]. | [[Echocardiography]] allows for assessment of the narrowing of the aortic valve opening area and the pressure gradient and velocity across the valve, which is increased in case of stenosis. It can also detect whether the aortic valve is bicuspid or tricuspid. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]], which is useful as pre-operative assessment if surgical treatment is considered. | ||
A chest radiograph may show enlarged left border of the heart and dilation of the ascending aorta. | A [[Chest radiography|chest radiograph]] may show enlarged left border of the heart and dilation of the ascending aorta. | ||
<section end="radiology" /> | <section end="radiology" /> | ||
== Treatment == | == Treatment == | ||