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7: AORTIC STENOSIS

Natalie V. Wessel, DO, MPH; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Aortic valve stenosis

  • Left ventricular outflow tract obstruction

  • Rheumatic aortic stenosis

  • Calcium aortic stenosis

ICD-9-CM CODES

  • 395.0 Rheumatic aortic stenosis

  • 396.0 Mitral valve stenosis and aortic valve stenosis

  • 746.3 Congenital stenosis of aortic valve

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERN

  • 6D: Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure1

PATIENT PRESENTATION

An 80-year-old male becomes short of breath while playing with his grandchildren at a family picnic. The patient states that he is dizzy and has chest pain. Vitals are: Pulse: 98, Respirations: 22, Blood pressure: 142/86, and SpO2% of 96%. On physical examination, the patient has a slow rate of rise in the carotid pulse, a systolic ejection murmur at the right second intercostal space and a reduced intensity of the second heart sound. The EKG reveals left ventricular hypertrophy, but no ST-T wave changes and a chest X-ray shows a rounding of the left ventricular apex.

KEY FEATURES

Description

  • 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

Essentials of Diagnosis

  • Stethoscope auscultation for ejection murmur at right second intercostal space

  • EKG/ECG3

  • Echocardiogram

  • Cardiac catheterization

  • Chest X-ray

  • Exercise stress test

General Considerations

  • Education on disease management reduces hospitalization

  • Patients with significant aortic stenosis (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

Demographics

  • 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

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Symptoms depend on the 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 ...

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