Aortic stenosis

Features of severe aortic stenosis

• narrow pulse pressure
• slow rising pulse
• delayed ESM
• soft/absent S2
• S4
• thrill
• duration of murmur
• left ventricular hypertrophy or failure

Causes of aortic stenosis

• degenerative calcification (most common cause in older patients > 65 years)
• bicuspid aortic valve (most common cause in younger patients < 65 years)
• William's syndrome (supravalvular aortic stenosis)
• post-rheumatic disease
• subvalvular: HOCM

Management

• if asymptomatic then observe the patient is general rule
• if symptomatic then valve replacement
• if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
• balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacement