Aortic Stenosis
Dr Swapnil Pawar
Aortic Stenosis Blog written by Dr Andrew Lam Clinical Characteristics of Mitral Regurgitation vs. Aortic Stenosis
| Aortic Stenosis | Mitral Regurgitation | | Character | Crescendo-Decrescendo Mid-Systolic Murmur | Pan-Systolic Murmur | | Radiation | To Carotids | To Axilla | | Location of Greatest Intensity | R. Upper Sternal Border | 5th Intercostal Space, Mid-Clavicular Line | | Variation With Respiration | Louder on expiration, softer on inspiration | Louder on expiration, softer on inspiration |
Grading of Aortic Stenosis
Stage A (At Risk of Aortic Stenosis) – asymptomatic patients who are at risk of aortic stenosis (i.e. bicuspid aortic valve or aortic sclerosis)
Stage B (Progressive Aortic Stenosis) – asymptomatic patients with mild-moderate disease
Stage C (Asymptomatic Severe Aortic Stenosis) – patients with findings suggestive of severe valve obstruction, but still remain asymptomatic
Stage D (Symptomatic Severe Aortic Stenosis) – Patients with severe valve obstruction but clinically also exhibit symptoms
Complications of Aortic Stenosis
Heart Failure
Left ventricular hypertrophy is common in the context of aortic stenosis. Consequently, patients develop diastolic heart failure, often with preserved ejection fractions. Due to increased diastolic pressures, patients can also develop pulmonary hypertension
Arrhythmias
Patients have an increased risk of ventricular and supraventricular arrhythmias, thought to be secondary to LV hypertrophy
Sudden Cardiac Death
The mechanism is not well established but appears to be reduced following valve replacement. Annual risk for severe asymptomatic AS is 1%, but for those with severe, symptomatic AS, rates range from 8-34%.
Endocarditis
Risk increases particularly in those with congenital abnormalities (i.e. bicuspid aortic valve)
Heyde Syndrome
A syndrome involving gastrointestinal bleeding from angiodysplasia in the context of aortic stenosis. Thought to be due to the high velocity of blood in aortic stenosis resulting in unravelling of von-Willebrand Factor that inhibits its function, and hence, promotes bleeding
References:
Otto, C.M. (2021) Clinical manifestations and diagnosis of aortic stenosis in adults. UpToDate. Retrieved 18th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-aortic-stenosis-in-adults
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