Aortic Stenosis

Causes of aortic stenosis (AS) include degenerative sclerosis with calcification of a trileaflet aortic valve, calcification of a congenital aortic bicuspid valve, or rheumatic fever. Narrowing of the aortic valve obstructs blood flow from the left ventricle to the ascending aorta during systole. Left untreated, patients with AS may develop heart failure, angina, syncope, exertional dyspnea, and arrhythmias.

A crescendo-decrescendo systolic murmur is heard at the right second intercostal space, which radiates to the carotids. Pulsus parvus et tardus is seen in severe AS, in which there is a weak and delayed carotid upstroke. Testing includes CXR, ECG, echocardiography, and cardiac catheterization to assess valve area and coronary arteries for atherosclerotic disease.

Asymptomatic adults with AS do not typically require intervention. Severe AS is treated with valve replacement or balloon valvuloplasty in young patients or poor surgical candidates.