1. AORTIC STENOSISA Review for the Internist,Hospitalist, and Family Physician R.B.Whiting,MD,MACP,FACC

2. C D 3. VALVULAR AORTIC STENOSIS

Congenital

Acquired

Rheumatic

Degenerative(age related)

Atherosclerotic

Calcific AS associated with Pagets Disease,

end-stage renal failure, rheumatoid arthritis,

etc.

4. AORTIC SCLEROSIS

Irregular thickening of the valve leaflets seen on

echo but without significant obstruction.May

result in a systolic ejection murmur.

Approx. 25% over age 65 and over 40% over 85

Evidence suggests Ao sclerosis does progress to

degenerative aortic stenosis.

5. AORTIC SCLEROSIS

Cosmi et al studied 2000 pts with aortic

sclerosis and found 16% progressed to

aortic stenosis and 10% had mild, 3%

moderate, and 2% severe obstruction.

The average time for progression from

ao sclerosis to severe stenosis was

8 years.

Arch Int Med 2002; 62:2345

6. Degenerative Aortic Stenosis

Most common type of AS today and the usual cause for aortic valve replacement

Shares common risk factors with mitral annular calcification

Risk factors for calcific aortic stenosis are similar to those for vascular atherosclerosis

7. 8. AORTIC STENOSIS

NATURAL HISTORY

May be asymptomatic for many years

Gradual onset and slow progression

LVH allows large gradient to be

tolerated for years with little or no

reduction of cardiac output, left

ventricular dilatation, or symptoms

9. AORTIC STENOSIS

Obstruction is progressive-but insidious

Rate of progression is variable so difficult to

predict in an individual patient

On average:AVA decreases 0.12 cm2/yr

with average increase jet velocity of

0.32 m/sec per year and mean gradient

increase of 7 mm Hg per year

10. AORTIC STENOSIS

Critical obstruction is associated with:

Peak gradient >50 mm Hg in presence

of normal output

Effective oriface area