Aortic stenosis (AS) is the most common valvular heart disease in the developed world and is associated with the aging population. AS is the narrowing of the heart’s aortic valve which reduces or blocks the blood flow from the heart to the rest of the body. AS is associated with exertional dyspnea, angina, and syncope. It typically gets worse over time and may lead to heart failure.
The most common cause of aortic stenosis is the calcification of the aortic valve which occurs with age. The accumulation of calcium deposits causes the aortic valve to stiffen and narrow over time. As a result, the left ventricle must generate a higher pressure with each contraction to pump blood efficiently. The increased pressure causes cardiac remodeling and thickening of the ventricular wall results, further impairing the heart’s ability to pump blood efficiently. Less commonly, a congenital bicuspid valve and rheumatic fever may also cause aortic stenosis.
A crescendo-decrescendo, mid-systolic ejection murmur that is heard best at the upper right sternal border, and radiates along the carotid arteries. The recommended patient position is sitting upright.
There are no specific ECG changes for aortic stenosis (AS), however the high pressure load on the left ventricle can lead to ECG patterns characteristic of left ventricular hypertrophy.