“Narrowing of the aortic valve, impeding delivery of blood from the LV to the body”

Risk Factors
  • Age – valve calcification (most common)
  • Congenital – Bicuspid valve
  • Rheumatic fever
  • Endocarditis
  • Heart disease risk factors – hypercholesterolemia, HTN, smoking, insulin resistance, diabetes, overweight, lack of activity, family history

Valve doesn’t open fully → obstruction to ventricular emptying → early systolic murmur

NB. Pulmonary stenosis = same sounding murmur, in a different location and it doesn’t radiate


Pressure gradient develops between LV and aorta: LV function initially maintained through hypertrophy → LV function declines when compensatory mechanisms are exhausted

Clinical Presentation
  • Symptoms
    • Chest pain
    • Weakness/dizziness –
      presyncope / syncope
    • Dyspnoea
    • HF → PND, orthopnoea, frothy sputum
  • Signs
    • Ejection systolic murmur → Heard on right 2nd intercostal space & radiates to carotid arteries
    • Slow rising pulse
    • Hypotension
    • Pulsus bisferiens
  • Bloods:
    • FBC, U+E, glucose, lipids
  • Imaging:
    • Chest X-Ray – Cardiomegaly (enlarged LV) / calcification of aortic ring
    • Echocardiogram – Direct visualization of valve dysfunction, assess the severity of AS
    • CT/MRI scan – more detailed image of heart and valves and assess the ascending aorta
  • Special:
    • ECG – LV hypertrophy / Left ventricular strain
  • Conservative:
    • Smoking Cessation
    • Dietary advice
  • Medical:
    • Statins
    • Anti-hypertensives
    • Anti-arrhythmic drugs
    • Beta-blockers
    • ACEi, diuretics
  • Surgical:
    • Valve replacement (mechanical or bioprosthetic)
    • Transcatheter aortic valve implantation
    • Balloon valvuloplasty

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