Epidemiology

Etiology

• Aortic valve sclerosis: calcification and fibrosis of aortic valve leaflets
  • Most common cause of aortic stenosis
  • Occurs at an increasing rate as patients age (prevalence is 35% in those aged 75–85 years)
  • Similar pathophysiology to atherosclerosis
• Bicuspid aortic valve (BAV): fusion of two of the three aortic-valve leaflets in utero
  • Most common congenital heart valve malformation, predominantly affects males (3:1)
  • Predisposes the valve to dystrophic calcification and degeneration
  • Patients present with symptoms of aortic stenosis earlier than in regular aortic valve calcification.

Pathophysiology

Clinical features

• Signs and symptoms
  • Dyspnea (typically exertional)
  • Angina pectoris
    • Due to increased LV oxygen demand and reduced coronary flow reserve
      • Impaired ventricular filling during diastole results in a reduced stroke volume. Compensatory tachycardia maintains cardiac output but tachycardia is associated with a shortened diastole, thereby reducing the coronary filling time. The hypertrophic LV also compresses the coronary arteries, further reducing the coronary reserve.
  • Dizziness and syncope
• Auscultation
  • Harsh crescendo-decrescendo (diamond-shaped), late systolic ejection murmur that radiates bilaterally to the carotids
    • Best heard in the 2nd right intercostal space
    • Handgrip decreases the intensity of the murmur.
    • Valsalva and standing from squatting decreases or does not change the intensity of the murmur (in contrast to hypertrophic cardiomyopathy).
  • Soft S2
    • A soft S2 results from a delay in the aortic component (A2) and softer closing of the aortic valve due to reduced mobility.
  • S4 is best heard at the apex.
    • Because of decreased compliance of the LV
  • Early systolic ejection click
    • Results from the abrupt stop of the valve leaflets upon opening

Diagnostics

Treatment