Aortic Stenosis – AS
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Aortic Stenosis is the narrowing of the three cusps that form the aortic valve. It is distinct from aortic sclerosis which is generally a milder precursor to aortic stenosis.

Aortic Stenosis is typically progressive, with symptoms becoming gradually worse over time. The first presentation usually occurs with shortness of breath on exertion.



  • Bicuspid Valve
  • Williams Syndrome

Senile Calcification

  • THE most common cause
  • Look for corneal arcus
Aortic Stenosis
Aortic Stenosis seen on post mortem. The aorta has been removed in this image to better demonstrate the aortic valve


  • Ejection Systolic murmur best heard in the aortic area, ( Right 2nd intercostal space at border of sternum), radiating to the caroitds.
  • Slow-rising pulse, with a narrow pulse pressure (difference between systolic and diastolic pressures is small)
  • Heave – but apex beat is not displaced
  • Possible signs of:


  • Angina
  • Syncope
  • Dyspnoea
  • Signs of any valve defect
    • Fatigue
    • Dyspnoea



  • L – LBBB – due do calcification
  • L – Left Axis Deviation
  • L – LVH
  • P – Poor R wave progression (i.e. depolarisation of the ventricles is slow)

Doppler Echo

Used to estimate the pressure across the valve.

  • 0 mmHg – normal valve
  • <30 mmHg – mild aortic stenosis
  • 30-50 mmHg – moderate aortic stenosis
  • >50 mmHg – severe aortic stenosis

Cardiac Catheterisation 

This can assess the actual gradient across the valve as well as check for co-existing CAD


If untreated
This can be predicted with the presence of symptoms:
  • Angina present – 2 years
  • Syncope present – 1 year
  • Dyspnoea present – 6 months


  • Surgicalif symptomatic, then the prognosis is poor (above) and prompt valve replacement is recommended. Valve replacement is also recommended for patients with ECG signs, and moderate to severe disease on Doppler / cardiac catheterisation.
    • Patients should be placed on antibiotics to prevent bacterial endocarditis
Valve replacements

Prosthetic – last about 10 years, after which time, may require another replacement. No need for long term anticoagulant therapy.
Metal last a life time, but require anticoagulant therapy for life. Also noisy (often make a loud ‘click’ sound). There are three types of metal valve

  • Tilting disc
  • Double tilting disc
  • Ball in a cage


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

This Post Has One Comment

  1. Stewart Brown

    The prognosis section is a bit mixed up. It should read

    This can be predicted with the presence of symptoms:
    Dyspnoea present – 2 years
    Angina present – 1 year
    Syncope present – 6 months

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