Overview
Definition
Narrowing of the aortic valve opening, which restricts blood flow from the left ventricle to the aorta.
Epidemiology
The most common valvular heart disease in developed countries. Prevalence increases significantly > 65 years.
Etiology & Risk Factors
- Senile calcific degeneration (most common in elderly)
- Bicuspid aortic valve (most common in younger patients)
- Rheumatic heart disease (common in developing nations)
Clinical Symptoms
- Classic Triad: SAD - Syncope, Angina, Dyspnea on exertion
- Delayed/diminished carotid pulse (Pulsus parvus et tardus)
Clinical Approach
Diagnosis
- Echocardiogram (diagnostic - evaluates valve area and pressure gradient)
- Auscultation: Systolic crescendo-decrescendo murmur at the right upper sternal border, radiating to carotids
- ECG: Left ventricular hypertrophy (LVH)
Management
- Aortic Valve Replacement (AVR) - Surgical (SAVR) or Transcatheter (TAVR) is the only definitive treatment
- Medical therapy has limited efficacy and is only for symptom control (use diuretics with extreme caution as these patients are preload dependent)
Complications
- Sudden cardiac death
- Left ventricular failure
- Arrhythmias