For Patients & General Readers

Aortic stenosis is a condition where the aortic valve in your heart narrows, making it harder for blood to flow from your heart to the rest of your body. This often happens as people age or due to birth defects. It's important to manage because it can lead to serious heart problems and symptoms like chest pain and fatigue.

Clinical Overview

Aortic stenosis (AS) is a progressive valvular heart disease characterized by narrowing of the aortic valve orifice, leading to left ventricular outflow obstruction. It is the most common form of valvular heart disease in developed countries, with increasing prevalence in the elderly due to degenerative calcification.

Clinical Presentation

Left ventricular pressure overload leading to hypertrophy and eventual dilation.
Increased myocardial oxygen demand and reduced coronary perfusion pressure.
Potential for diastolic dysfunction and pulmonary hypertension.
Risk of atrial fibrillation and ventricular arrhythmias.
Progressive decline in functional capacity and increased mortality if untreated.

Signs & Symptoms

Symptoms (Patient-Reported)

Angina (chest pain) or chest tightness, often exertional
Dyspnea (shortness of breath), especially on exertion or when lying flat
Syncope (fainting) or presyncope, particularly with exertion
Palpitations
Fatigue and reduced exercise tolerance
Dizziness

Signs (Clinician-Observed)

Harsh systolic ejection murmur at the right upper sternal border, often radiating to the carotids
Paradoxical splitting of the second heart sound (S2) in severe AS
Diminished or delayed carotid pulses (pulsus parvus et tardus)
Signs of heart failure (e.g., peripheral edema, jugular venous distension) in advanced stages

Differential Diagnoses

Condition	Distinguishing Feature
Aortic sclerosis	Aortic sclerosis involves thickening and calcification of the aortic valve leaflets without significant stenosis or hemodynamic impact; typically presents with a soft systolic murmur, if any.
Hypertrophic cardiomyopathy (HCM)	HCM can cause a systolic murmur due to dynamic left ventricular outflow tract obstruction, but the murmur is often best heard at the left sternal border and may increase with Valsalva maneuver, unlike the fixed obstruction of AS.
Pulmonic stenosis	Pulmonic stenosis is a right-sided outflow obstruction, presenting with a systolic murmur at the left upper sternal border and distinct from the aortic area murmur and carotid radiation of AS.
Mitral regurgitation	Mitral regurgitation is a holosystolic murmur heard best at the apex and radiating to the axilla, distinct from the ejection murmur of AS.
Ventricular septal defect (VSD)	A VSD typically causes a holosystolic murmur heard best at the left lower sternal border, with varying intensity depending on the size of the defect.
Anemia	Anemia can cause a flow murmur due to increased cardiac output, but it is typically softer, shorter, and lacks the characteristic radiation and S2 changes of significant AS.

Red Flags — Seek Immediate Care

New onset or worsening syncope, especially exertional
Severe dyspnea at rest or with minimal exertion
Chest pain suggestive of myocardial ischemia
Hemodynamic instability or signs of cardiogenic shock

Key Investigations

Transthoracic echocardiogram (TTE) is the cornerstone for diagnosis and severity assessment, measuring valve area, gradients, and LV function.
Transesophageal echocardiogram (TEE) may be used for better visualization of valve morphology and for pre-procedural planning.
Electrocardiogram (ECG) to assess for LV hypertrophy, arrhythmias, or signs of ischemia.
Cardiac catheterization may be performed to confirm gradients and assess for concomitant coronary artery disease, especially in patients undergoing surgical intervention.
Chest X-ray to assess for cardiomegaly or pulmonary congestion.

Management Overview

Management of aortic stenosis depends on symptom status and severity. Asymptomatic patients with severe AS require close monitoring with serial echocardiograms. Symptomatic severe AS or severe AS with LV dysfunction typically warrants aortic valve replacement (AVR) via surgical AVR (SAVR) or transcatheter aortic valve replacement (TAVR), chosen based on patient anatomy, comorbidities, and surgical risk.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. TruelyserMD does not replace clinical judgement.