Clinical assessment of the severity of aortic stenosis

Abstract

Valvular aortic stenosis (AS) has three primary etiologies: age-related degenerative calcification, congenital bicuspid valve with superimposed calcification, and rheumatic disease. Despite the progressive histopathological changes that lead to anatomical alteration of the aortic valve apparatus, aortic stenosis has a long asymptomatic period. Eventually, AS results in predictable pathophysiologic alterations in cardiac pressures and blood flow that elicit the classic symptomatology and physical stigmata of this disease. The development of symptoms signals an abrupt worsening in prognosis. An appreciation of these pathophysiologic derangements is essential to the clinical assessment of aortic valve obstruction.