Aortic stenosis causes

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Aortic Stenosis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4], Priyamvada Singh, MBBS [5], Mohammed A. Sbeih, M.D. [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]

Overview

Aortic stenosis can be categorized under two methods of causation: acquired and congenital. Research regarding the influence of preventative therapies on causation is mixed. More research is needed specifically looking at cholesterol lowering interventions and their role on disease onset.

Complete Differential Diagnosis for the Causes of Aortic Stenosis

Cardiovascular .
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Some medications may cause aortic stenosis, such as
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Radiation.
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic .
Iatrogenic Radiation treatment to the chest.
Infectious Disease Bacterial endocarditis where the vegetations may favor increase risk of stenosis.
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic .
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy .
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes


The etiology of Left-Sided Outflow Obstruction can be divided into two broad categories:

  1. Acquired Aortic Stenosis and
  2. Congenital Left-Sided Outflow Obstruction

Major causes and predisposing conditions of aortic stenosis include acute rheumatic fever and bicuspid aortic valve. As individuals age, calcification of the aortic valve may occur and result in stenosis. This is especially likely to occur in people with a bicuspid aortic valve, but also occurs in the setting of perfectly normal valves as a result of age-induced 'wear and tear'. Typically, aortic stenosis due to calcification of a bicuspid valve occurs in the 4th of 5th decade of life, whereas symptomatic onset due to calcification of a normal valve tends to occur later - around the 7th or 8th decade.

Of the various forms of aortic stenosis, the calcific type is predominant. Since calcific aortic stenosis shares many pathological features and risk factors with atherosclerosis. As atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been interest in attempting to modify the course of calcific aortic stenosis by cholesterol lowering with statin drugs. Although a number of small, observational studies demonstrated an association between lowered cholesterol and decreased progression, and even regression, of calcific aortic stenosis. A large randomized clinical trial, published in 2005, failed to find any predictable effect of cholesterol lowering on calcific aortic stenosis. Researchers in 2007 study conversely demonstrated a slowing of aortic stenosis with the statin rosuvastatin.[1] More research is necessary to further clarify the specific mechanisms of disease onset and the influence of interventional methodologies on overall causation.

Congenital bicuspid valve is the most frequent form of congenital heart disease affecting approximately 1-2% of the population. 1/3rd of Supravalvular Aortic Stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have Williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).

Differential Diagnosis of the Causes of Aortic Stenosis

References

  1. Moura LM, Ramos SF, Zamorano JL; et al. (2007). "Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis". J. Am. Coll. Cardiol. 49 (5): 554–61. doi:10.1016/j.jacc.2006.07.072. PMID 17276178.

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