Obstruction to LV outflow due to narrowed aortic valve; severe if peak velocity ≥4 m/s, mean gradient ≥40 mmHg, valve area ≤1 cm².
Causes
- • Calcific degeneration (>65 y)
- • Bicuspid valve (40–60 y)
- • Rheumatic heart disease
Clinical features
- • Exertional dyspnoea
- • Angina
- • Syncope (mean survival 2–3 y after onset)
Examination
- • Slow-rising pulse, narrow pulse pressure
- • Heaving apex
- • Ejection systolic murmur radiating to carotids, soft S2
Investigations
- • ECG (LVH, LBBB)
- • TTE (gradient, area, EF)
- • Coronary angiography pre-op if symptoms / risk factors
Management
- • Avoid vasodilators / ACEi if severe + symptoms
- • AVR (surgical or TAVI) when symptomatic OR EF <50 OR very severe asymptomatic
- • TAVI preferred age ≥75 or high surgical risk
Complications
- • Heart failure
- • Sudden cardiac death
- • AF, conduction disease
Clinical pearls
- • Symptom onset is the trigger for AVR, not absolute gradient
References
- • ESC Valvular Heart Disease 2021
Educational — verify locally.
