cardiovascular disorders
Aortic Stenosis
Key Points
The most common cause of aortic stenosis (AS) in patients<70 years is bicuspid aortic valve; aortic sclerosis is the most common precursor in older patients. Untreated AS ultimately results in exertional syncope, angina, and dyspnea; sudden death may occur. Typical heart sounds are a crescendo-decrescendo ejection murmur that increases with maneuvers that increase left ventricular (LV) volume and contractility (eg, leg-raising, squatting, Valsalva release) and decreases with maneuvers that decrease LV volume (Valsalva maneuver) or increase afterload (isometric handgrip). Nitrates may cause dangerous hypotension and should be used with caution for angina in patients with AS. Exercise testing is particularly useful in risk stratification and timing of surgery for patients without clear symptoms. Replacement is indicated once symptoms begin or LV dysfunction occurs. Surgical or transcatheter aortic valve replacement are options for many patients, but long-term safety data are lacking for transcatheter aortic valve replacement (especially in low-risk patients). 