AORTIC STENOSIS

OBJECTIVES:
● Definition
● Etiology
● Pathophysiology
● Clinical Features
Definition:

Aortic stenosis is the narrowing of aortic valve

resulting in obstruction of blood flow from the left
ventricle to the ascending aorta during systole .
The normal aortic valve area is 3 to 4 cm2 , when the area is less than this , it is called aortic stenosis.
In severe aortic stenosis,valve area is less than 1 cm2
Etiology:
Pathophysiology:
>Obstruction to left ventricular outflow leads to
increased left ventricular pressure and compensatory
concentric hypertrophy.
>The hypertrophied LV muscle mass elevates
myocardial oxygen requirements.
>In addition, coronary vessels may be compressed by
increased intraventricular pressure leading to
decreased blood flow. Both these factors lead to
ischemia of myocardium which increases on exertion.
>Since there is obstruction to LV outflow, cardiac
output cannot increase on exertion, which leads to
exertional syncope, chest pain and dyspnea.
>Syncope and light-headedness is due to decreased
cerebral perfusion.
>BP may also drop during exertion due to peripheral
vasodilation.
>Ultimately, left ventricle may dilate and fail.
Clinical Features:
SYMPTOMS
-Angina,
-Dyspnoea,
-Syncope,
-Dizziness,
-Sudden death (may be as a result of intolerance to
complete heart block or atrial tachyarrhythmia).

-Pure aortic valve disease may remain asymptomatic for

10–15 years.
 SIGNS
• Slow rising, small volume pulse
• Heaving apex beat
• S4 may be heard
• Ejection click (indicates valvular AS and excludes
supra and subvalvular AS; disappears on
calcification of aortic valve)
• Carotid thrill (shudder) is felt
• A rough, ejection systolic murmur loudest in the
aortic area radiating to the carotids and the apex
• AS murmur – low pitched, rough, rasping in character