Cardiology · Pathway 13
Aortic Stenosis
Key points
- Symptomatic disease: chest pain · dyspnoea · syncope — symptomatology guides the timing of surgery
- Severe AS: narrow pulse pressure · slow rising pulse · delayed ESM · soft/absent S2 · S4 · thrill · duration of murmur · LVH or failure
- Causes: degenerative calcification (most common > 65 y) · bicuspid aortic valve (most common < 65 y) · William's syndrome (supravalvular) · post-rheumatic disease · subvalvular HOCM
- Management: asymptomatic → observe · symptomatic → valve replacement · asymptomatic with gradient > 40 mmHg plus features such as LV systolic dysfunction → consider surgery
- Balloon valvuloplasty limited to critical aortic stenosis in patients not fit for valve replacement
Decision points in this pathway
- Symptomatic?
- Valvular gradient > 40 mmHg with features such as left ventricular systolic dysfunction?
The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.