Q. Clinical Features of aortic stenosis?

Patients with congenital aortic stenosis usually present in childhood or adolescence. Those with rheumatic heart disease present during 30-50 years and with bicuspid valve between 40-60 years. Degenerative aortic valve disease patients present late in elderly age group. There is no direct correlationship with severity of disease and presence or absence of symptoms. However, those with mean transaortic gradient of more than 60 mmHg are often symptomatic. Symptoms include dizziness or syncope, angina and those of heart failure. Dizziness or syncope may be due to arrhythmias or LV dysfunction but more often due to inappropriate baroreceptor function that results in vasodilatation in the presence of fixed cardiac output.

Angina is noted in approximately 50-60 per cent of patients and in about 50 per cent of these patients it is due to associated CAD. Onset of heart failure symptoms usually portends poor prognosis. The life span is usually considered to be 5, 3 and 2 years after the onset of symptoms of angina, heart failure and syncope respectively.

While infective endocarditis may affect non calcified valves, it is uncommon to affect calcific valves. However, micro emboli from calcific valves may occur. Lower G.I. bleeding due to angiodysplasia of ascending colon is a known association of severe valvular aortic stenosis.