Aortic Stenosis

Aortic valve is too small, narrow, or stiff, resulting in the obstruction of blood flow from the left ventricle to the aorta during systole

Aetiology

  • Younger patients: usually from a congenital bicuspid valve
  • Older patients: usually from calcifications on aortic valve
  • Rheumatic heart disease is the next most common

Clinical presentation

Symptoms

  • There are usually no symptoms until aortic stenosis is moderately severe
  • At this stage, exercise-induced syncope, angina and dyspnoea develop

Signs

  • Ejection systolic murmur best heard at the 2nd right intercostal space right sternal edge (aortic area)
  • Radiates to carotids

Investigations

  • CXR
  • ECG
  • Echocardiogram
  • Others if indicated: CMR, cardiac CT

Management

  • Conventional valve replacement (preferred)
  • Patients who would not tolerate an operation under anaesthesia - TAVI