Calixtro, Laidelle Jascinth M.

BSN – III

NARRATIVE PATHOPHYSIOLOGY OF AORTIC VALVE STENOSIS

Aortic stenosis is one of the most common and severe problems with valve disease. Aortic
stenosis is a narrowing of the opening of the aortic valve. Aortic stenosis limits the flow of blood
from the left ventricle to the aorta and can also affect the pressure in the left atrium. Aortic valve
stenosis is narrowing of the orifice between the left ventricle and aorta. In adults, stenosis often is
a result of degenerative calcifications. Calcifications may be caused by proliferative and
inflammatory changes that occur in response to years of normal mechanical stress, similar to
changes that occur in atherosclerotic arterial disease (Cheever, K. 2018).
Some individuals have aortic stenosis due to a congenital heart defect called a bicuspid
aortic valve, this disorder occurs more frequently during aging when calcium or scarring affects
the valve and reduces the amount of blood flowing through it. However, age, diabetes,
hypercholesterolemia, hypertension, smoking, and elevated levels of low density lipoprotein
cholesterol are also the common etiological factors of this condition. These factors affect the aorta
as they cause the valve to wear and tear over the years of aging, which disrupts the
endothelium valve and the underlying matrix. Untreated Group A streptococcus URTI can also
result in molecular mimicry, anti-strep antibodies incorrectly attacking the valve, causing
inflammation of the endocardium valve. There is a presence of fibrosis and calcification of the
aortic valve, causing an inhibition of blood flow through the aortic valve, which may cause
syncope to the patient. Left ventricle contracts harder to pump blood to the stenotic valve.
This leads in two following reasons: left atrium dilates and hypertrophies as a result of the
pressure overload. The cardiac output is more dependent on the atrial filling of the left ventricle,
resulting in atrial fibrillation; the rigid, hypertrophic left ventricle and the high left ventricle
pressure both make the left ventricle more difficult to fill, resulting in a decrease in cardiac output.
Pressure overload in the left ventricle backs into the lung vasculature, contributing to pulmonary
congestion. There is a transudation of fluid through alveolar walls into airspace, which causes the
patient to experience dyspnea and upon auscultation, diffuse crackles can be heard. If this condition
continues to persists it may lead to various complications of aortic stenosis such as heart failure,
stroke, thrombosis, bleeding, arrhythmias, endocarditis, and worse, death. The prognosis for Aortic
Stenosis is good, as long as there is prompt medical attention, if the worst case scenario occurs,
surgery could be suggested. Early identification is also crucial to reducing the progression of
complications.
REFERENCES

Aortic Stenosis Overview. (n.d.). Retrieved November 03, 2020, from

https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-
problems-and-causes/problem-aortic-valve-stenosis
Hinkle, J. L., Brunner, L. S., Suddarth, D. S., & Cheever, K. L. (2018). Brunner & Suddarth's
textbook of medical-surgical nursing. Philadelphia: Wolter Kluwer.

What is the prognosis of severe aortic stenosis (AS)? (2019, November 10). Retrieved November
03, 2020, from https://www.medscape.com/answers/150638-44342/what-is-the-prognosis-
of-severe-aortic-stenosis-as