Aortic stenosis is narrowing of the aortic valve, causing obstruction of blood flow from the left ventricle (LV) to the aorta.
Most Common Cause: Age-related Calcification & Rheumatic Heart Disease (RHD)
Mnemonic: "AS = Aorta Shrinks (Narrow Valve)"
CAUSES OF AORTIC
STENOSIS
1. Common Causes
- Age-Related Degeneration (Calcific AS – Most Common in Elderly).
- Congenital Bicuspid Aortic Valve (Common in Young Adults).
- Rheumatic Heart Disease (With Aortic Regurgitation & Mitral Valve Disease).
Mnemonic: "A.C.R." (Aging, Congenital, Rheumatic)
PATHOPHYSIOLOGY
OF AS
- Aortic Valve Narrows → LV Works Harder to Pump Blood
- Left Ventricular Hypertrophy (LVH) Develops → Stiff LV
- Reduced Cardiac Output → Less Blood Reaches Body
- Late Stage → Heart Failure (Weak LV & Blood Backs Up in Lungs)
Mnemonic: "N.L.R.H." (Narrow → LV Hypertrophy → Reduced Output → Heart Fails)
SYMPTOMS OF
AORTIC STENOSIS (AS)
"Aortic Stenosis TRIAD" (3 Classic Symptoms)
- Breathlessness (Dyspnea – Due to Heart Failure).
- Chest Pain (Angina – Due to High LV Pressure).
- Syncope (Fainting – Due to Low Blood Flow to Brain).
Mnemonic: "B.C.S." (Breathless, Chest Pain, Syncope)
SIGNS &
MURMURS IN AS
Pulse: Slow Rising Pulse (Delayed & Weak
– "Pulsus Tardus et Parvus").
Apex Beat: Sustained & Heaving (Due to
LVH).
Heart Sounds:
- Soft S2 (Aortic Valve Not Closing
Properly).
- Ejection Click (Only in Young Patients
with Congenital AS).
- Systolic Murmur (Harsh
Crescendo-Decrescendo, Best Heard at 2nd ICS, Right Side).
Mnemonic: "S.E.S." (Slow Pulse, Ejection Click, Systolic Murmur)
DIAGNOSIS OF
AORTIC STENOSIS
ECG:
- Left Ventricular Hypertrophy (LVH)
with Strain Pattern.
Chest X-ray:
- Aortic Valve Calcification, Normal
Heart Size.
Echocardiography (Best Test!)
- Confirms AS Severity & LV
Function.
Mnemonic: "E.C.E." (ECG, CXR, Echo – Best Test)
TREATMENT OF
AORTIC STENOSIS
1. MEDICAL
MANAGEMENT (For Mild-Moderate AS)
- Avoid Strenuous Exercise (To Prevent Sudden Death).
- Diuretics (For Heart Failure – But Use Caution!).
- Beta-Blockers (Reduce LV Workload).
Mnemonic: "A.D.B." (Avoid Exercise, Diuretics, Beta-Blockers)
2. SURGICAL
MANAGEMENT (For Severe AS or Symptoms)
- Aortic Valve Replacement (AVR) – Gold Standard!
- Balloon Valvuloplasty (For Young Patients or Temporary Relief).
Mnemonic: "V.B." (Valve Replacement, Balloon Valvuloplasty)
COMPLICATIONS OF
AORTIC STENOSIS
- Heart Failure (Due to Stiff LV).
- Sudden Cardiac Death (Due to Arrhythmia).
- Atrial Fibrillation (If Left Atrium Overloads).
- Infective Endocarditis (Due to Damaged Valve).
Mnemonic: "H.S.A.I." (Heart Failure, Sudden Death, AFib, Infection)
DIFFERENTIAL
DIAGNOSIS (CONDITIONS THAT MIMIC AS)
- Hypertrophic Cardiomyopathy (HCM): Similar murmur, but increases with standing (Unlike AS).
- Aortic Sclerosis: Murmur is present, but valve opening is normal.
- Pulmonary Stenosis (PS): Murmur heard best at left side (Unlike AS on Right Side).
Mnemonic: "H.A.P." (HCM, Aortic Sclerosis, Pulmonary Stenosis)
PREVENTION OF
AORTIC STENOSIS
- Early Treatment of Rheumatic Fever (Penicillin Prophylaxis).
- Regular Follow-up for Valve Disease.
- Control Hypertension & Diabetes (Prevent Valve Calcification).
Mnemonic: "P.R.C." (Penicillin, Regular Check-ups, Control BP & Sugar)
FINAL REVISION WITH MNEMONICS
- Definition = "AS = Aorta Shrinks (Narrow Valve)"
- Causes = "A.C.R." (Aging, Congenital, Rheumatic)
- Pathophysiology = "N.L.R.H." (Narrow → LV Hypertrophy → Reduced Output → Heart Fails)
- Symptoms = "B.C.S." (Breathless, Chest Pain, Syncope – Aortic Stenosis Triad)
- Signs & Murmurs = "S.E.S." (Slow Pulse, Ejection Click, Systolic Murmur)
- Diagnosis = "E.C.E." (ECG, CXR, Echo – Best Test)
- Medical Treatment = "A.D.B." (Avoid Exercise, Diuretics, Beta-Blockers)
- Surgical Treatment = "V.B." (Valve Replacement, Balloon Valvuloplasty)
- Complications = "H.S.A.I." (Heart Failure, Sudden Death, AFib, Infection)
- Differential Diagnosis = "H.A.P." (HCM, Aortic Sclerosis, Pulmonary Stenosis)
- Prevention = "P.R.C." (Penicillin, Regular Check-ups, Control BP & Sugar)
