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  • Aortic valve stenosis
  • Left ventricular outflow tract obstruction
  • Rheumatic aortic stenosis
  • Calcium aortic stenosis

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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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  • 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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Description

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Essentials of Diagnosis

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  • Stethoscope auscultation for ejection murmur at right second intercostal space
  • EKG/ECG3
  • 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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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 pectoris2
  • Syncope2
  • Congestive heart failure2
  • Dyspnea on exertion
  • Shortness of breath2
  • Anginal chest pain that increases with exercise
  • Orthopnea2
  • Fatigue, weakness2
  • 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 coronary syndrome
  • Mitral regurgitation
  • Mitral stenosis
  • Mitral valve prolapse
  • Myocardial infarction
  • Shock, hypovolemia
  • Cardiac pump dysfunction
    • Cardiac muscle dysfunction produces slight-to-moderate reduction in cardiac output (CO)
    • Mild-to-moderate activity limitation
    • Functional capacity of ⩽ 5 to 6 metabolic ...

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