Obstruction to LV outflow at valvular level.
Causes
- • Calcific/degenerative (elderly)
- • Bicuspid valve (young)
- • Rheumatic
Clinical features
- • Classic triad: angina, syncope, dyspnoea
Examination
- • Ejection systolic murmur radiating to carotids
- • Slow-rising pulse
- • Narrow pulse pressure
- • Soft A2
Investigations
- • Echo: valve area, mean gradient, jet velocity
- • Severe: AVA <1 cm², mean grad >40, Vmax >4 m/s
Management
- • Symptomatic severe AS → AVR (SAVR or TAVI)
- • TAVI preferred if high surgical risk / elderly / bicuspid in selected
- • Avoid nitrates and vasodilators (preload sensitive)
Complications
- • HF, SCD, AF, endocarditis
Clinical pearls
- • Once symptomatic, mortality 50% at 2 years without valve replacement
- • Low-flow low-gradient AS may need dobutamine stress echo
References
- • ESC/EACTS 2021 Valvular
- • AHA/ACC 2020 Valvular
Educational — verify locally.
