BMJ  2008;336:550-555 (8 March), doi:10.1136/bmj.39478.498819.AD

Clinical Review

Degenerative aortic stenosis

¹ Department of Internal Medicine, Section of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, 1501, N Campbell Avenue, Tucson, AZ 85724, USA, ² Section of Cardiology, Sarver Heart Center, University of Arizona College of Medicine

The first 150 words of the full text of this article appear below.

Summary points Although aortic stenosis is common, its diagnosis may be missed Calcific aortic stenosis shares many common features with atherosclerosis After the onset of symptoms, the average survival is two to three years, and patients with symptoms of syncope, angina, and dyspnoea need prompt aortic valve replacement Endocarditis prophylaxis is indicated in all patients with aortic stenosis Echocardiography should be performed once aortic stenosis is suspected. Coronary artery angiography is usually needed before aortic valve replacement, except in young patients Careful exercise testing should be considered in asymptomatic patients with severe aortic stenosis who are sedentary or unable to give a clear history

Aortic stenosis is the most common valvular lesion in Europe and North America. It primarily presents as calcific aortic stenosis in 2-7% of the population aged >65 years.¹ About 80% of adult patients with symptomatic aortic stenosis are male. As 1-2% of the population is born with a . . . [Full text of this article]

What are the factors leading to aortic stenosis?

How is the haemodynamic severity of aortic stenosis classified?

Box 1 Grading of aortic stenosis⁵
Mild stenosis
Moderate stenosis
Severe stenosis

How do we diagnose aortic stenosis?

Clinical diagnosis
Radiological diagnosis

What is the natural course of aortic stenosis?

What are the medical treatments for aortic stenosis?

What is the definitive treatment for aortic stenosis?

Is age a contraindication for aortic valve replacement?

Box 2 Joint Recommendations of American Heart Association and American College of Cardiology for aortic valve replacement in patients with aortic stenosis⁵
Aortic valve replacement indicated
Aortic valve replacement possibly indicated
Box 3 Recommendations of European Society of Cardiology for follow-up in patients with aortic stenosis⁶

How can the progression of aortic stenosis be predicted?

Box 4 Predictors of progression of aortic stenosis⁶
Clinical
Echocardiography
Exercise testing

Conclusion

Sources and selection criteria
Differences between the European and the US guidelines*
Tips for non-specialists
Additional educational resources
Unanswered research questions
Ongoing research

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