Aortic stenosis

This chapter presents the background, challenges, high-risk markers, high-risk predictors, investigations, smart testing, and management for aortic stenosis (AS). Patients with severe AS and clinical evidence of congestive heart failure (HF) and low cardiac output manifested by syncope are risk markers for short-term mortality. Important co-morbidities such as chronic obstructive lung disease (COPD), advanced chronic kidney disease (CKD), peripheral vascular disease (PVD) and severe liver disease will increase surgical risk. The electrocardiogram in severe AS shows the non-specific findings of LV hypertrophy and left atrial enlargement. Two-dimensional echocardiography provides an important morphologic characterization of the stenotic aortic valve. There is no effective medical therapy for AS. Despite the significant overlap in the cardiovascular (CV) risk factors for AS and atherosclerosis, trials to date have not shown benefit in AS from commonly used medical therapies for atherosclerosis. Hypertension and AS are both characterized by increased pressure afterload resulting in LV hypertrophy.