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Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ...
The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ...
// I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic...
// I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic...
// Q00-Q99 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q07) Congenital malformations of the nervous system (Q00) Anencephaly and similar malformations (Q01) Encephalocele (Q02) Microcephaly (Q03) Congenital hydrocephalus (Q04) Other congenital malformations of brain (Q05) Spina bifida (Q06) Other congenital malformations of spinal cord (Q07) Other congenital malformations of nervous...
The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ...
The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ...
The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ...
MedlinePlus (medlineplus. ...
eMedicine is an online clinical medical knowledge base that was founded in 1996. ...
The aortic valve is one of the valves of the heart. ...
The aortic valve controls the direction of blood flow from the left ventricle to the aorta. When in good working order, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis, often abbreviated as AS. The aortic valve is one of the valves of the heart. ...
In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ...
The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ...
Pathophysiology
 Simultaneous left ventricular and aortic pressure tracings demonstrate a pressure gradient between the left ventricle and aorta, suggesting aortic stenosis. The left ventricle generates higher pressures than what is transmitted to the aorta. The pressure gradient, caused by aortic stenosis, is represented by the green shaded area. (AO = ascending aorta; LV = left ventricle; ECG = electrocardiogram.) When the aortic valve becomes stenotic, it causes a pressure gradient between the left ventricle (LV) and the aorta.[1] The more constricted the valve, the higher the gradient between the LV and the aorta. For instance, with a mild AS, the gradient may be 20 mmHg. This means that, at peak systole, while the LV may generate a pressure of 140 mmHg, the pressure that is transmitted to the aorta will only be 120 mmHg. So, while a blood pressure cuff may measure a normal systolic blood pressure, the actual pressure generated by the LV would be considerably higher. Image File history File links Aortic_stenosis_rheumatic,_gross_pathology_20G0014_lores. ...
Image File history File links Aortic_stenosis_rheumatic,_gross_pathology_20G0014_lores. ...
Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...
Post-mortem, postmortem and post mortem redirect here. ...
Image File history File links Download high resolution version (848x988, 333 KB)Simultaneous left ventricular and aortic pressure tracings, demonstrating a pressure gradient, which is due to aortic stenosis. ...
Image File history File links Download high resolution version (848x988, 333 KB)Simultaneous left ventricular and aortic pressure tracings, demonstrating a pressure gradient, which is due to aortic stenosis. ...
One way of defining pressure is in terms of the height of a column of fluid that may be supported by that pressure; or the height of a column of fluid that exerts that pressure at its base. ...
BP 126/70 mmHg as result on electronic sphygmomanometer A sphygmomanometer or blood pressure meter is a device used to measure blood pressure, comprising an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. ...
Systole can mean the following: Systole (medicine) is a term describing the contraction of the heart. ...
A sphygmomanometer, a device used for measuring blood pressure. ...
For other forms of hypertension, see Hypertension (disambiguation). ...
In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased afterload caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the myocardium (muscle) of the LV undergoes hypertrophy (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened. In cardiac physiology, afterload is the tension produced by a chamber of the heart in order to contract. ...
Myocardium is the muscular tissue of the heart. ...
Left ventricular hypertrophy (LVH) is the abnormal thickening of the myocardium (muscle) of the left ventricle of the heart. ...
Etiology Major causes and predisposing conditions of aortic stenosis include acute rheumatic fever and bicuspid aortic valve. As individuals age, calcification of the aortic valve may occur and result in stenosis. This is especially likely to occur in people with a bicuspid aortic valve, but also occurs in the setting of perfectly normal valves as a result of age-induced 'wear and tear'. Typically, aortic stenosis due to calcification of a bicuspid valve occurs in the 4th of 5th decade of life, whereas that due to calcification of a normal valve tends to occur later - around the 7th or 8th decade. Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...
A normal aortic valve has three cusps. ...
The aortic valve is one of the valves of the heart. ...
Of the various forms of aortic stenosis, the calcific type is predominant. Since calcific aortic stenosis shares many pathological features and risk factors with atherosclerosis, and since atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been interest in attempting to modify the course of calcific aortic stenosis by cholesterol lowering with statin drugs. Although a number of small, observational studies demonstrated an association between lowered cholesterol and decreased progression, and even regression, of calcific aortic stenosis, a recent, large randomized clinical trial, published in 2005, failed to find any predictable effect of cholesterol lowering on calcific aortic stenosis. Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceuticals to lower cholesterol levels in people at risk for cardiovascular disease because of hypercholesterolemia. ...
In statistics, the goal of an observational study is to draw inferences about the possible effect of a treatment on subjects, where the assignment of subjects into a treated group versus a control group is outside the control of the investigator. ...
A randomised controlled trial (RCT), also known as randomised clinical trial, is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...
Prevalence Aortic stenosis is a common problem. Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85 have the disorder. In North America and Europe, at least, the population is aging. Hence, the prevalence of aortic stenosis is increasing. Since the disease carries with it considerable morbidity and mortality, both with large personal and economic impact, aortic stenosis is a major health problem.
Symptoms of aortic stenosis When symptomatic, aortic stenosis can cause dizziness, syncope, angina and congestive heart failure. More symptoms indicate a worse prognosis. Treatment requires replacement of the diseased valve with either a prosthetic aortic valve. In medicine, a disease is symptomatic when it is at a stage when the patient is experiencing symptoms. ...
This article or section does not cite its references or sources. ...
angina tonsillaris see tonsillitis. ...
Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ...
The aortic valve is one of the valves of the heart. ...
It has been suggested that this article or section be merged with Heart valve prosthesis. ...
Congestive heart failure Congestive heart failure (CHF) is a grave prognosis in patients with AS. Patients with CHF that is attributed to AS have a 2 year mortality rate of 50%, if the aortic valve is not replaced. Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ...
CHF in the setting of AS is due to a combination of systolic dysfunction (a decrease in the ejection fraction) and diastolic dysfunction (elevated filling pressure of the LV). In cardiovascular physiology, ejection fraction (Ef) is the fraction of blood pumped out of a ventricle with each heart beat. ...
Syncope Syncope in the setting of heart failure increases the risk of death. In patients with syncope, the 3 year mortality rate is 50%, if the aortic valve is not replaced. The term Faint redirects here. ...
It is unclear why aortic stenosis causes syncope. One popular theory is that severe AS produces a nearly fixed cardiac output. When the patient exercises, their peripheral vascular resistance will decrease as the blood vesels of the skeletal muscles dilate to allow the muscles to receive more blood to allow them to do more work. This decrease in peripheral vascular resistance is normally compensated for by an increase in the cardiac output. Since patients with severe AS cannot increase their cardiac output, the blood pressure falls and the patient will syncopize due to decreased blood perfusion to the brain. This article or section does not cite its references or sources. ...
Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ...
Total peripheral resistance refers the cumulative resistance of the thousands of arterioles in the body, or the lungs, respectively. ...
Structure of a skeletal muscle Skeletal muscle is a type of striated muscle, attached to the skeleton. ...
A sketch of the human brain by artist Priyan Weerappuli, imposed upon his sketch of the profile of Michaelangelos David In animals, the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ...
A second theory as to why syncope may occur in AS is that during exercise, the high pressures generated in the hypertrophied LV cause a vasodepressor response, which causes a secondary peripheral vasodilation which in turn causes decreased blood flow to the brain. Indeed, in aortic stenosis, because of the fixed obstruction to bloodflow out from the heart, it may be impossible for the heart to increase its output to offset peripheral vasodilation. The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...
A sketch of the human brain by artist Priyan Weerappuli, imposed upon his sketch of the profile of Michaelangelos David In animals, the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ...
A third mechanism may sometimes be operative. Due to the hypertrophy of the left ventricle in aortic stenosis, including the consequent inability of the coronary arteries to adequately supply blood to the myocardium (see "Angina" below), arrhythmias may develop. These can lead to syncope. In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ...
The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ...
Myocardium is the muscular tissue of the heart. ...
A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ...
This article or section does not cite its references or sources. ...
Finally, in calcific aortic stenosis at least, the calcification in and around the aortic valve can progress and extend to involve the electrical conduction system of the heart. If that occurs, the result may be heart block - a potentially lethal condition of which syncope may be a symptom. The EKG complex. ...
A heart block is a disease in the electrical system of the heart. ...
Angina Angina in the setting of heart failure also increases the risk of death. In patients with angina, the 5 year mortality rate is 50%, if the aortic valve is not replaced. angina tonsillaris see tonsillitis. ...
Angina in the setting of AS is secondary to the left ventricular hypertrophy (LVH) that is caused by the constant production of increased pressure required to overcome the pressure gradient caused by the AS. While the myocardium of the LV gets thicker, the arteries that supply the muscle do not get significantly longer or bigger, so the muscle may become ischemic. The ischemia may first be evident during exercise, when the muscle requires increased blood supply to compensate for the increased workload. The individual may complain of exertional angina. At this stage, a stress test with imaging may be suggestive of ischemia. Left ventricular hypertrophy (LVH) is the abnormal thickening of the myocardium (muscle) of the left ventricle of the heart. ...
Myocardium is the muscular tissue of the heart. ...
Stress testing is a form of testing which is used to determine the stability of a given system or entity. ...
Eventually, however, the muscle will require more blood supply at rest than can be supplied by the coronary artery branches. At this point there may be signs of ventricular strain pattern on the EKG, suggesting subendocardial ischemia. The subendocardium is the region that becomes ischemic because it is the most distant from the epicardial coronary arteries. ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ...
Associated symptoms In Heyde's syndrome, aortic stenosis is associated with angiodysplasia of the colon. Recent research has shown that the stenosis causes a form of von Willebrand disease by breaking down its associated coagulation factor (factor VIII-associated antigen, also called von Willebrand factor), due to increased turbulence around the stenosed valve. Heydes syndrome is a syndrome of aortic valve stenosis associated with gastrointestinal bleeding from colonic angiodysplasia. ...
An angiodysplasia in the colon being treated with argon plasma coagulation administered via probe through the colonoscope. ...
For the article about the punctuation symbol, see Colon (punctuation). ...
Von Willebrands disease (vWD) is the most common hereditary coagulation abnormality described in humans. ...
The coagulation of blood is a complex process during which blood forms solid clots. ...
Factor VIII (FVIII) is an essential clotting factor. ...
Von Willebrand factor is a blood glycoprotein of the coagulation system. ...
Physical examination Aortic stenosis is most often diagnosed when it is asymptomatic and can sometimes be detected during routine examination of the heart and circulatory system. Good evidence exists to demonstrate that certain characteristics of the peripheral pulse can rule in the diagnosis[2]. In particular, there may be a slow and/or sustained upstroke of the arterial pulse, and the pulse may be of low volume. This is sometimes referred to as pulsus tardus et parvus. There may also be a noticeable delay between the first heart sound (on auscultation) and the corresponding pulse in the carotid artery (so-called 'apical-carotid delay'). Similarly, there may be a delay between the appearance of each pulse in the brachial artery (in the arm) and the radial artery (in the wrist). In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ...
In medicine, pulsus tardus et parvus, is a sign where, on palpation of the pulse, the pulse is late (tardus) (relative to contraction of the heart) and weak/small (parvus). ...
Auscultation is the technical term for listening to the internal sounds of the body, usually using a stethoscope. ...
The carotid artery is a major artery of the head and neck that supplies blood to the head and neck. ...
An easily heard systolic, crescendo-decrescendo (i.e. 'ejection') murmur is heard loudest at the upper right sternal border, and radiates to the carotid arteries bilaterally. The murmur increases with squatting, decreases with standing and isometric muscular contraction, which helps distinguish it from hypertrophic obstructive cardiomyopathy (HOCM). The murmur is louder during expiration, but is also easily heard during inspiration. The more severe the degree of the stenosis, the later the peak occurs in the crescendo-decrescendo of the murmur. Systole can mean the following: Systole (medicine) is a term describing the contraction of the heart. ...
Murmurs are abnormal heart sounds that are produced as a result of turbulent blood flow, which is sufficient to produce audible noise. ...
In human anatomy, the carotid artery is a major artery of the head and neck. ...
Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. ...
The 2nd heart sound tends to become softer as the aortic stenosis becomes more severe. This is a result of the increasing calcification of the valve preventing it from "snapping" shut and producing a sharp, loud sound. Due to increases in left ventricular pressure from the stenotic aortic valve, over time the ventricle may hypertrophy, resulting in a diastolic dysfunction. As a result, one may hear a 4th heart sound due to the stiff ventricle. With continued increases in ventricular pressure, dilatation of the ventricle will occur, and a 3rd heart sound may be manifest. Wiggers diagram. ...
Finally, aortic stenosis often co-exists with some degree of aortic insufficiency. Hence, the physical exam in aortic stenosis may also reveal signs of the latter, for example an early diastolic decrescendo murmur. Indeed, when both valve abnormalities are present, the expected findings of either may be modified or may not even be present. Rather, new signs emerge which relflect the presence of simultaneous aortic stenosis and insufficiency, e.g. pulsus bisferiens. Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
In medicine, pulsus bisferiens, also bisferious pulse, is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. ...
Peripheral signs include:
- a slow-rising, small volume carotid pulse
- narrowed pulse pressure
- sustained, thrusting apex beat which is usually not displaced unless the stenosis is severe
Diagnostic tests
Although aortic stenosis does not lead to any specific findings on the ECG, it still often leads to a number of electrocardiographic abnormalities. ECG manifestations of left ventricular hypertrophy (LVH) are common in aortic stenosis and arise as a result of the stenosis having placed a chronically high pressure load on the left ventricle (with LVH being the expected response to chronic pressure loads on the left ventricle no matter how caused). Lead II An electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical activity of the heart over time. ...
ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ...
Left ventricular hypertrophy (LVH) is the abnormal thickening of the myocardium (muscle) of the left ventricle of the heart. ...
In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ...
As noted below, the calcification process which occurs in aortic stenosis can progress to extend beyond the aortic valve and into the electrical conduction system of the heart. Evidence of this phenomenon may include heart block that is apparent on the ECG but otherwise undetectable. The EKG complex. ...
A heart block is a disease in the electrical system of the heart. ...
Heart catheterization The heart may be catheterized to directly measure the pressure on both sides of the aortic valve. The pressure gradient may be used as a decision point for treatment. Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. ...
Echocardiogram The aortic valve area is now usually calculated non-invasively using echocardiographic flow velocities. Aortic valve area calculation is an indirect method of determining the area of the aortic valve. ...
An echocardiogram. ...
Cautions People with aortic stenosis of any aetiology are at risk for the development of infection of their stenosed valve, i.e. infective endocarditis. To lessen the chance of developing that serious complication, people with AS are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of esophageal varices, dilation of esophageal strictures, gastrointestinal surgery where the intestinal mucosa will be disrupted, prostate surgery, urethral stricture dilation, and cystoscopy. Note that routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis. Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ...
In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ...
The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ...
The prostate is an exocrine gland of the male mammalian reproductive system. ...
A sterile flexible cystoscope in an operating theatre Hello this is a Message to Dad Quit Reading this stuff :) . Endoscopy of the urinary bladder via the urethra is called cystoscopy. ...
Endoscopic images of a duodenal ulcer Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ...
In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ...
Colonoscopy is the minimally invasive endoscopic examination of the large colon and the distal part of the small bowel with a fiber optic camera on a flexible tube passed through the anus. ...
A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ...
Since the stenosed aortic valve may limit the heart's output, people with aortic stenosis are at risk of syncope and dangerously low blood pressure should they use any of a number of common medications. Ironically, these same medicines are used to treat a variety of cardiovascular diseases, many of which may co-exist with aortic stenosis. Examples include nitroglycerin, nitrates, ACE inhibitors, terazosin (Hytrin), and hydralazine. Note that all of these substances lead to peripheral vasodilation. Normally, however, in the absence of aortic stenosis, the heart is able to increase its output and thereby offset the effect of the dilated blood vessels. In some cases of aortic stenosis, however, due to the obstruction of blood flow out of the heart caused by the stenosed aortic valve, cardiac output cannot be increased. Low blood pressure or syncope may ensue. This article or section does not cite its references or sources. ...
Nitroglycerin (NG), also known as nitroglycerine, trinitroglycerin, and glyceryl trinitrate, is a chemical compound. ...
Nitrates are the salts of nitric acid. ...
Captopril, the first ACE inhibitor ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ...
Terazosin (Hytrin) is an alpha blocker used for treatment of symptoms of prostate enlargement (BPH). ...
Hydralazine hydrochloride (1 -hydrazinophthalazine monohydrochloride; Apresoline®) is a medication used to treat high blood pressure. ...
The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...
Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ...
This article or section does not cite its references or sources. ...
Treatment
Medical Aortic stenosis may be medically treated to control symptoms.
Surgical Aortic stenosis requires aortic valve replacement if medical management does not successfully control symptoms. The aortic valve is one of the valves of the heart. ...
References - ^ Lilly LS (editor) (2003). Pathophysiology of Heart Disease, 3rd ed., Lippincott Williams & Wilkins. ISBN 0-7817-4027-4.
- ^ http://jama.ama-assn.org/cgi/content/abstract/277/7/564
External links - Aortic stenosis information from Seattle Children's Hospital Heart Center
- Mitral Valve Repair at The Mount Sinai Hospital
- The Patient's Guide To Aortic Valve Replacement Due To Aortic Stenosis
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