Clinical manifestations and diagnosis of aortic stenosis in adults
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
Aortic valve stenosis is the most common cause of left ventricular outflow obstruction in children and adults; less common causes are subvalvular or supravalvular disease (table 1). This topic will review the clinical features, diagnosis, and evaluation of valvular aortic stenosis (AS).
The pathogenesis, epidemiology, natural history, medical therapy, and percutaneous and surgical valve interventions for AS are discussed separately. (See "Natural history, epidemiology, and prognosis of aortic stenosis" and "Medical management of asymptomatic aortic stenosis in adults" and "Indications for valve replacement in aortic stenosis in adults" and "Choice of prosthetic heart valve for surgical replacement" and "Transcatheter aortic valve replacement: Indications and outcomes" and "Percutaneous balloon aortic valvotomy".)
Symptoms — The classic clinical manifestations of aortic stenosis (AS) are heart failure (HF), syncope, and angina. However, these "classic" manifestations reflect end-stage disease. Now, with earlier diagnosis by echocardiography and prospective followup of patients, the following are the most common presenting symptoms (see early symptoms in (figure 1)):
●Dyspnea on exertion or decreased exercise tolerance
●Exertional dizziness (presyncope) or syncope
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- CLINICAL MANIFESTATIONS
- - Dyspnea and decreased exercise tolerance
- - Dizziness and syncope
- - Angina pectoris
- Physical examination
- - Carotid pulse
- - Precordial palpation
- - Cardiac auscultation
- Chest radiograph
- DIAGNOSIS AND EVALUATION
- When to suspect aortic stenosis
- Approach to diagnosis and evaluation
- Stress testing
- B-type natriuretic peptide
- Cardiovascular magnetic resonance
- Computed tomography
- Cardiac catheterization
- DIFFERENTIAL DIAGNOSIS
- Subvalvular disease
- Supravalvular disease
- Sudden cardiac death
- Bleeding tendency
- Embolic events
- Concurrent coronary disease
- INFORMATION FOR PATIENTS