Aortic Stenosis (cont.)

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What might the doctor find in patients with aortic stenosis?

The carotid arteries carry blood from the aorta to the brain and are the closest arteries to the aortic valve that can be felt by the doctor examining the neck. Patients with significant aortic stenosis have a delayed upstroke and lower intensity of the carotid pulse which correlates with the severity of narrowing. Aortic valve stenosis causes significant turbulence to blood flowing during contraction of the left ventricle resulting in a loud murmur. The loudness of the murmur does not, however, correlate with the severity of stenosis. Patients with mild stenosis can have loud murmurs, while patients with severe stenosis and heart failure may not pump enough blood to cause much of a murmur.

How is aortic stenosis diagnosed?

Electrocardiogram (EKG): An EKG is a recording of the heart's electrical activity. Abnormal patterns on the EKG can reflect a thickened heart muscle and suggest the diagnosis of aortic stenosis. In rare instances, electrical conduction abnormality can also been seen.

Chest X-rayA chest X-ray usually shows a normal heart shadow. The aorta above the aortic valve is often enlarged (dilated). If heart failure is present, fluid in the lung tissue and larger blood vessels in the upper lung regions are often seen. A careful inspection of the chest X-ray sometimes reveals calcification of the aortic valve.

Echocardiography: Echocardiography uses ultrasound waves to obtain images of the heart chambers, valves, and surrounding structures. It is a useful non-invasive tool, which helps doctors diagnose aortic valve disease. An echocardiogram can show a thickened, calcified aortic valve which opens poorly. It can also show the size and functioning of the heart chambers. A technique called Doppler can be used to determine the pressure difference on either side of the aortic valve and to estimate the aortic valve area.

Cardiac catheterization: Cardiac catheterization is the gold standard in evaluating aortic stenosis. Small hollow plastic tubes (catheters) are advanced under X-ray guidance to the aortic valve and into the left ventricle. Simultaneous pressures are measured on both sides of the aortic valve. The rate of blood flow across the aortic valve can also be measured using a special catheter. Using these data, the aortic valve area can be calculated. A normal aortic valve area is 3 square centimeters. Symptoms usually occur when the aortic valve area narrows to less than 1 square centimeter. Critical aortic stenosis is present when the valve area is less than 0.7 square centimeters. In patients over 40 years of age, X-ray contrast agents can be injected into the coronary arteries (coronary angiography) during cardiac catheterization to evaluate the status of coronary arteries. If significant narrowing of the coronary arteries is found, coronary artery bypass graft surgery (CABG) can be performed during aortic valve replacement surgery.

Medically Reviewed by a Doctor on 8/27/2012

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