Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Aortic valve stenosisLeft ventricular outflow tract obstructionRheumatic aortic stenosisCalcium aortic stenosis ++ 395.0 Rheumatic aortic stenosis396.0 Mitral valve stenosis and aortic valve stenosis746.3 Congenital stenosis of aortic valve ++ I06.0 Rheumatic aortic valve diseasesI35.0 Aortic (valve) stenosisI35.2 Aortic (valve) stenosis with insufficiencyQ23.0 Congenital stenosis of aortic valve ++ 6D: Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure1 +++ Description ++ Aortic valve does not open fully2Narrowing of the aortic valve causing left ventricular outflow tract obstruction2Causes decreased blood flow from left ventricle into the ascending aortaDecreases blood flow from heart to rest of the body and brainDecreased flow can cause lightheadedness, fainting, chest painThree types2CongenitalRheumaticDegenerative +++ Essentials of Diagnosis ++ Stethoscope auscultation for ejection murmur at right second intercostal spaceEKG/ECG3EchocardiogramCardiac catheterizationChest x-rayExercise stress test +++ General Considerations ++ Education on disease management reduces hospitalizationPatients with significant AS should not participate in competitive sports, even without symptomsStrenuous activity should be limited for symptomatic ASSigns and symptoms should be monitoredEmphasis on wellness and preventionCan lead to sudden cardiac death, arrhythmias, increased risk of bleeding, embolic events, coronary diseaseChildren can develop bacterial endocarditisCan cause syncope, chest pain, heart failure if untreated +++ Demographics ++ Can be congenital, present from birthMore commonly develops later in life as a result of calcification of the valve or previous rheumatic feverMore common in men than women +++ Signs and Symptoms ++ Symptoms depend on degree of valve stenosisPatient may have no symptoms until stenosis progressesAudible systolic ejection murmur at right second intercostal spaceAngina pectoris2Syncope2Congestive heart failure2Dyspnea on exertionShortness of breath2Anginal chest pain that increases with exerciseOrthopnea2Fatigue, weakness2Fainting, dizziness with activityPalpitationsPalpable heaves/thrills over precordiumPulsus parvus et tardus: faint pulse or altered quality of pulse in the neckArrhythmiasEndocarditis +++ Functional Implications ++ Mild-to-moderate stenosis generally does not cause symptomsSevere AS causes progressive shortness of breath, may be subtlePatients may be unaware of reduced cardiovascular capacity +++ Possible Contributing Causes ++ Causes of AS include2Individuals with a 2-leaflet aortic valve instead of 3-leafletAge-related progressive calcificationCalcification of congenital bicuspid aortic valveAcute rheumatic feverCoronary artery diseaseDiabetes mellitusHyperlipoproteinemiaHypertensionUremiaOlder age +++ Differential Diagnosis ++ Acute coronary syndromeMitral regurgitationMitral stenosisMitral valve prolapseMyocardial infarctionShock, hypovolemiaCardiac pump dysfunctionCardiac muscle dysfunction produces slight-to-moderate reduction in cardiac output (CO)Mild-to-moderate activity limitation... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.