What is Aortic Stenosis?

Aortic Stenosis lesion occurs in 25% of all patients with chronic valvular heart disease of rheumatic origin. The primary abnormality is an obstruction to the left ventricle output. There is reduced cardiac output and a gradually dilating left ventricle and hypertrophy of the heart muscle. Aortic valvular stenosis may follow rheumatic fever but is more commonly caused by progressive valvular calcification (see illustration). This may occur in younger patients with a congenitally bicuspid valve or in elderly individuals with normal three-cusp valves. In the latter group, the aortic valve becomes sclerotic and, with further calcification, stenotic. Approximately 25% of patients over age 65 years and 35% of those over age 70 years have echocardiographic evidence of sclerosis, which appears to be related to atherosclerotic vascular disease and is associated with a higher rate of vascular events. About 10–20% of these will progress to hemodynamically significant aortic stenosis over a period of 10–15 years.

Symptoms and Signs of Aortic Stenosis

Symptoms of failure may be sudden in onset or may progress gradually. Angina pectoris frequently occurs in aortic stenosis. One-half of patients with calcific aortic stenosis and angina have significant associated coronary artery disease, whereas coronary disease is noted at only half this rate in the absence of angina. Syncope is typically exertional and may be due to arrhythmias (usually ventricular tachycardia but sometimes sinus bradycardia), hypotension, or decreased cerebral perfusion resulting from increased blood flow to exercising muscle without compensatory increase in cardiac output. Sudden death may occur but is rarely the initial manifestation of aortic stenosis in previously asymptomatic patients.

Clinical Features of Aortic Stenosis

1. Middle-aged individuals affected.
2. Breathlessness.
3. Anginal pain.
4. Dizziness and syncope.

Management of Aortic Stenosis

1. Consult a physician.
2. Replacement of valve.

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