Calcific aortic stenosis

Abstract

The clinical features of aortic stenosis have been well described and are familiar to all practising physicians. Despite this, the diagnosis is often delayed, especially in the elderly. In order to determine the possible reasons for this delay we analysed the records of 115 consecutive patients undergoing valve replacement for calcific aortic stenosis in Papworth Hospital. The prognosis of patients with symptomatic aortic stenosis is poor. The average length of survival of those with angina is 2-3 years and it is less following the onset of cardiac failure. The results of surgery are good. There were seven deaths within 30 days of operation in our 115 patients (6 per cent), and a low late morbidity and mortality. It is not our intention to discuss these results here but merely to point out that once the correct diagnosis has been established the symptoms can be alleviated and the prognosis improved. We conclude that the diagnosis of aortic stenosis remains difficult even though aetiology and presentation have changed little over the past few decades. The diagnosis should be considered in any patient presenting with a cardiac murmur and angina pectoris or heart failure. A lateral chest X-ray and, when available, echocardiography are the best screening tests.