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Aortic Stenosis
BY JORGE MUNIZ, PA-C

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 Causes of aortic stenosis (AS) include degenerative sclerosis with calci!cation of a trilea"et
aortic valve, calci!cation of a congenital aortic bicuspid valve, or rheumatic fever. Narrowing
of the aortic valve obstructs blood "ow from the left ventricle to the ascending aorta during
systole. Left untreated, patients with AS may develop heart failure, angina, syncope,
exertional dyspnea, and arrhythmias.

A crescendo-decrescendo systolic murmur is heard at the right second intercostal space,

which radiates to the carotids. Pulsus parvus et tardus is seen in severe AS, in which there is
a weak and delayed carotid upstroke. Testing includes CXR, ECG, echocardiography, and
cardiac catheterization to assess valve area and coronary arteries for atherosclerotic
disease.

Asymptomatic adults with AS do not typically require intervention. Severe AS is treated with
valve replacement or balloon valvuloplasty in young patients or poor surgical candidates.

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