Aortic valve is too small, narrow, or stiff, resulting in the obstruction of blood flow from the left ventricle to the aorta during systole

Aetiology

• Younger patients: usually from a congenital bicuspid valve
• Older patients: usually from calcifications on aortic valve
• Rheumatic heart disease is the next most common

Clinical presentation

Symptoms

• There are usually no symptoms until aortic stenosis is moderately severe
• The classic triad of symptoms are: heart failure, syncope, and angina
  • These symptoms are associated with end-stage aortic stenosis
• Other features include exertional dyspnoea and decreased exercise tolerance

Signs

• Ejection systolic murmur best heard at the 2nd right intercostal space right sternal edge (aortic area)
• Radiates to carotids
• Slow rising carotid pulse
• Narrow pulse pressure

Investigations

• CXR: can often show evidence of cardiomegaly and evidence of a calcified aortic valve if that is the cause
• ECG: increased QRS complex voltage, left axis deviation, poor R-wave progression
• Echocardiogram: primary test for diagnosis and evaluation of severity
• Others if indicated: cardiac MRI, cardiac CT, exercise testing