​Pathology - Aortic Stenosis

​Pathology - Aortic Stenosis 
Aortic stenosis is a medical condition characterized by the narrowing of the aortic valve, which obstructs the flow of blood from the heart to the rest of the body.

The causes of aortic stenosis include senile/degenerative calcific aortic stenosis (which happens in persons over the age of 60), congenital bicuspid valve, and rheumatic heart disease.

The aortic valve is affected by calcific deposits on its cusps, resulting in calcitic aortic stenosis. This condition involves fibrosis of the cusps and commissural fusion, which is commonly associated with rheumatic heart disease.

Pathophysiology: The narrowing of the aortic valve causes an increased pressure gradient, which in turn leads to an increase in the workload of the left ventricle. This higher workload results in the thickening of the left ventricle and a loss in its ability to relax and expand. Ultimately, left ventricular failure ensues. Angina occurs due to an imbalance between the amount of oxygen supplied to the heart muscle (caused by reduced compliance leading to the compression of blood vessels within the heart muscle) and the increased demand for oxygen caused by increased stress on the left ventricular wall.

Exhibits symptoms of chest pain, fainting, and congestive heart failure.
The physical examination reveals a gentle second heart sound (S2) and a harsh, late-peaking crescendo. The patient has a systolic ejection murmur that decreases in intensity and can be felt in the neck. Additionally, they have weak and delayed carotid pulses, which means that the pulses in their neck are weaker and slower relative to their heart sounds.

Treatment of hypertension; surgical or percutaneous valve replacement for patients with significant aortic stenosis with symptoms or reduced ejection fraction.