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Condition/Disorder Synonyms

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  • Aortic valve stenosis

  • Left ventricular outflow tract obstruction

  • Rheumatic aortic stenosis

  • Calcium aortic stenosis

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ICD-9-CM Codes

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  • 395.0 Rheumatic aortic stenosis

  • 396.0 Mitral valve stenosis and aortic valve stenosis

  • 746.3 Congenital stenosis of aortic valve

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ICD-10-CM Codes

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  • I06.0 Rheumatic aortic valve diseases

  • I35.0 Aortic (valve) stenosis

  • I35.2 Aortic (valve) stenosis with insufficiency

  • Q23.0 Congenital stenosis of aortic valve

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Preferred Practice Pattern

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Key Features

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Description

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  • Aortic valve does not open fully2

  • Narrowing of the aortic valve causing left ventricular outflow tract obstruction2

  • Causes decreased blood flow from left ventricle into the ascending aorta

  • Decreases blood flow from heart to rest of the body and brain

  • Decreased flow can cause lightheadedness, fainting, chest pain

  • Three types2

    • Congenital

    • Rheumatic

    • Degenerative

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Essentials of Diagnosis

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  • Stethoscope auscultation for ejection murmur at right second intercostal space

  • EKG/ECG 3

  • Echocardiogram

  • Cardiac catheterization

  • Chest x-ray

  • Exercise stress test

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General Considerations

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  • Education on disease management reduces hospitalization

  • Patients with significant AS should not participate in competitive sports, even without symptoms

  • Strenuous activity should be limited for symptomatic AS

  • Signs and symptoms should be monitored

  • Emphasis on wellness and prevention

  • Can lead to sudden cardiac death, arrhythmias, increased risk of bleeding, embolic events, coronary disease

  • Children can develop bacterial endocarditis

  • Can cause syncope, chest pain, heart failure if untreated

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Demographics

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  • Can be congenital, present from birth

  • More commonly develops later in life as a result of calcification of the valve or previous rheumatic fever

  • More common in men than women

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Clinical Findings

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Signs and Symptoms

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  • Symptoms depend on degree of valve stenosis

  • Patient may have no symptoms until stenosis progresses

  • Audible systolic ejection murmur at right second intercostal space

  • Angina pectoris 2

  • Syncope 2

  • Congestive heart failure 2

  • Dyspnea on exertion

  • Shortness of breath 2

  • Anginal chest pain that increases with exercise

  • Orthopnea 2

  • Fatigue, weakness 2

  • Fainting, dizziness with activity

  • Palpitations

  • Palpable heaves/thrills over precordium

  • Pulsus parvus et tardus: faint pulse or altered quality of pulse in the neck

  • Arrhythmias

  • Endocarditis

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Functional Implications

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  • Mild-to-moderate stenosis generally does not cause symptoms

  • Severe AS causes progressive shortness of breath, may be subtle

  • Patients may be unaware of reduced cardiovascular capacity

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Possible Contributing Causes

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  • Causes of AS include2

    • Individuals with a 2-leaflet aortic valve instead of 3-leaflet

    • Age-related progressive calcification

    • Calcification of congenital bicuspid aortic valve

    • Acute rheumatic fever

    • Coronary artery disease

    • Diabetes mellitus

    • Hyperlipoproteinemia

    • Hypertension

    • Uremia

    • Older age

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Differential Diagnosis

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  • Acute ...

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