Aortic stenosis

Aortic Stenosis is a valvular heart condition characterised by the of the narrowing valve opening, restricting blood flow from the left ventricle to the aorta

• • Degenerative: Age-related calcific changes (most common in elderly).

• • Congenital: Bicuspid aortic valve, which becomes calcified and stenotic in adulthood.

• • Rheumatic: Rheumatic heart disease following streptococcal pharyngitis.

• • Progressive valve narrowing → increased left ventricular (LV) afterload → compensatory LV hypertrophy.

• • With time, this may lead to diastolic dysfunction, heart failure and increased myocardial oxygen demand.

• Classic Triad: Dyspnoea, angina, and syncope on exertion.
• Physical Examination: Slow-rising pulse, narrow pulse pressure, ejection systolic murmur heard best at the right upper sternal border with radiation to the carotids.

• • ECG: Signs of LV hypertrophy.

• • Chest X-ray: Cardiomegaly, calcified aortic valve.

• • Echocardiography: Gold standard; measures valve area, gradient, and assesses LV function.

• Conservative: Lifestyle modifications, regular monitoring, endocarditis prophylaxis if needed.
• Medical: Limited role, but can use diuretics for symptoms of heart failure. Antihypertensives cautiously.
• Surgical: Aortic valve replacement (mechanical or bioprosthetic) is the definitive treatment. Indicated in symptomatic patients or those with LV dysfunction. Balloon valvuloplasty may be considered in selected cases.

• Left ventricular failure.
• Arrhythmias.
• Sudden cardiac death.
• Endocarditis (rare).

• AS is the most common valvular heart disease in the developed world.
• The classic triad of symptoms often suggests severe stenosis.
• Echocardiography is pivotal in the diagnosis and assessment of AS.

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