Aortic stenosis can be congenital or acquired in origin.
The most common congenital abnormality is the bicuspid aortic valve, Significant narrowing of the orifice usually occurs during middle age after years of turbulent flow through the valve results in leaflet injury thickening, and calcification. Rheumatic aortic stenosis results from fusion of the leaflet commissures and is usually associated with mitral valve disease The most common cause of aortic stenosis in adults is degenerative or senile aortic stenosis, which usually occurs in patients older than the age of 65.Aortic stenosis is more common in men than women In patients with aortic stenosis, the outflow obstruc tion gradually increases over many years, resulting in left ventricular h This response allows the left ventricle to generate and maintain a large pressure gradient across the valve without a reduction in stroke volume.
However, left ventricular hypertrophy results in increased diastolic wall stiffness such that greater intra cavitary pressure is required to maintain left ventricular Patients with severe aortic stenosis may be a symptomatic for many years despite the presence of severe obstruction. The cardinal symptoms associated with aor tic stenosis are angina, cope, and congestive heart failure.
Angina can occur in coronary disease because of the increased of the hypertrophied decreased coronary blood flow secondary to elevated left ventricular lar diastolic pressure, Syncope may result from transient arrhythmias but more commonly occurs with exertion when the cardiac output is insufficient to maintain arterial pressure in the presence of exercise-induced peripheral vasodilation.
Dyspnea may result from diastolic dysfunction associated with the noncompliant , hypertrophied left ventricle or may signal the onset of systolic dysfunction that may develop late in the course of this disease.