Transcript
- 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