Difference between revisions of "Calcific aortic stenosis"

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#redirect [[Heart_valves#Calcific_aortic_stenosis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Calcific aortic stenosis -- very low mag.jpg
| Width      =
| Caption    = Aortic valve stenosis. [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[infective endocarditis]] (may be a concurrent pathology), [[bicuspid aortic valve]],[[rheumatic heart disease]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = thickened calcified valve
| Grossing  =
| Site      = aortic valve - see ''[[heart valves]]''
| Assdx      =
| Syndromes  = [[bicuspid aortic valve]] if in younger individuals (50s)
| Clinicalhx =
| Signs      = syncope
| Symptoms  = dyspnea (usu. first symptom), angina
| Prevalence = common
| Bloodwork  =
| Rads      = thickened valve, reduced flow area, usu. no vegetation
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = [[infective endocarditis]], [[bicuspid aortic valve]], [[rheumatic heart disease]]
| Tx        = valve replacement
}}
'''Calcific aortic stenosis''', abbreviated '''CAS''', is a very common disease of the aortic [[heart valves|valve]]. It typically afflicts the elderly.


In younger individuals the valve is typically abnormal ([[bicuspid aortic valve]] or unicuspid aortic valve).
==General==
*Somewhat similar to [[atherosclerosis]]; however, considered a separate entity.<ref>{{cite journal |author=Otto CM |title=Calcific aortic stenosis--time to look more closely at the valve |journal=N. Engl. J. Med. |volume=359 |issue=13 |pages=1395-8 |year=2008 |month=September |pmid=18815402 |doi=10.1056/NEJMe0807001 |url=}}</ref>
*Mitral valve is usually normal.
*Most common cause of aortic stenosis.
DDx of aortic stenosis:
#Calcific aortic stenosis.
#[[Bicuspid aortic valve]] with calcific aortic stenosis.
#[[Rheumatic heart disease]].
Clinical (mnemonic ''SAD''):
*Syncope.
*Angina.
*[[Dyspnea]] (shortness of breath) - first symptom.
==Gross==
*Thickened, calcific appearing valve.
Drop test:
*Makes a "ting" sound when landing on a metal surface.
==Microscopic==
Features:<ref name=Ref_PBoD590>{{Ref PBoD|590}}</ref>
*[[Dystrophic calcification]]<ref name=pmid12779138>{{Cite journal  | last1 = Novaro | first1 = GM. | last2 = Griffin | first2 = BP. | title = Calcific aortic stenosis: another face of atherosclerosis? | journal = Cleve Clin J Med | volume = 70 | issue = 5 | pages = 471-7 | month = May | year = 2003 | doi =  | PMID = 12779138 | URL = http://www.ccjm.org/cgi/pmidlookup?view=long&pmid=12779138 }}</ref> - affects the valsalva side of the valve.
**It affects the fibrosa.
*Primarily at the base of the valve, i.e. there is relative sparing the free edge.
Note:
*There should be no [[neutrophil]]s and no microorganisms.
*An expanded spongiosa layer may be seen in the context of calcification.{{fact}}
DDx:
*[[Infective endocarditis]] - inflammatory cells (esp. neutrophils), microorganisms (e.g. cocci).
*[[Bicuspid aortic valve]].
*[[Rheumatic heart disease]].
===Images===
<gallery>
Image: Calcific aortic stenosis -- very low mag.jpg | CAS - very low mag.
Image: Calcific aortic stenosis - alt -- very low mag.jpg | CAS - very low mag.
Image: Calcific aortic stenosis -- low mag.jpg | CAS - low mag.
Image: Calcific aortic stenosis -- intermed mag.jpg | CAS - intermed. mag.
Image: Calcific aortic stenosis - valve -- very low mag.jpg | CAS - very low mag.
Image: Calcific aortic stenosis - valve -- low mag.jpg | CAS - very low mag.
Image: Calcific aortic stenosis - valve - cropped -- low mag.jpg | CAS - low mag.
Image: Calcific aortic stenosis - valve -- intermed mag.jpg | CAS - intermed. mag.
</gallery>
<gallery>
File:Aortic valve stenosis, HE 1.jpg | CAS. (WC/Patho)
File:Aortic valve stenosis, HE 2.jpg | CAS. (WC/Patho)
File:Aortic valve stenosis, HE 3.jpg | CAS. (WC/Patho)
File:Aortic valve stenosis, HE 4.jpg | CAS. (WC/Patho)
File:Aortic valve stenosis, HE 5.jpg | CAS. (WC/Patho)
</gallery>
==Sign out==
<pre>
AORTIC VALVE, VALVE REPLACEMENT:
- CALCIFIC AORTIC STENOSIS.
</pre>
===Micro===
The sections show valve tissue with marked calcification of the fibrosa layer. No neutrophils are identified. No microorganisms are identified with routine stains.
==See also==
*[[Heart valves]].
*[[Atherosclerosis]].
*[[Congestive heart failure]].
==References==
{{Reflist|2}}
[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Cardiovascular pathology]]

Latest revision as of 19:47, 15 November 2015

Calcific aortic stenosis
Diagnosis in short

Aortic valve stenosis. H&E stain.
LM DDx infective endocarditis (may be a concurrent pathology), bicuspid aortic valve,rheumatic heart disease
Gross thickened calcified valve
Site aortic valve - see heart valves
Syndromes bicuspid aortic valve if in younger individuals (50s)
Signs syncope
Symptoms dyspnea (usu. first symptom), angina
Prevalence common
Radiology thickened valve, reduced flow area, usu. no vegetation
Clin. DDx infective endocarditis, bicuspid aortic valve, rheumatic heart disease
Treatment valve replacement

Calcific aortic stenosis, abbreviated CAS, is a very common disease of the aortic valve. It typically afflicts the elderly.

In younger individuals the valve is typically abnormal (bicuspid aortic valve or unicuspid aortic valve).

General

  • Somewhat similar to atherosclerosis; however, considered a separate entity.[1]
  • Mitral valve is usually normal.
  • Most common cause of aortic stenosis.

DDx of aortic stenosis:

  1. Calcific aortic stenosis.
  2. Bicuspid aortic valve with calcific aortic stenosis.
  3. Rheumatic heart disease.

Clinical (mnemonic SAD):

  • Syncope.
  • Angina.
  • Dyspnea (shortness of breath) - first symptom.

Gross

  • Thickened, calcific appearing valve.

Drop test:

  • Makes a "ting" sound when landing on a metal surface.

Microscopic

Features:[2]

  • Dystrophic calcification[3] - affects the valsalva side of the valve.
    • It affects the fibrosa.
  • Primarily at the base of the valve, i.e. there is relative sparing the free edge.

Note:

  • There should be no neutrophils and no microorganisms.
  • An expanded spongiosa layer may be seen in the context of calcification.[citation needed]

DDx:

Images

  • CAS - very low mag.

  • CAS - very low mag.

  • CAS - low mag.

  • CAS - intermed. mag.

  • CAS - very low mag.

  • CAS - very low mag.

  • CAS - low mag.

  • CAS - intermed. mag.

  • CAS. (WC/Patho)

  • CAS. (WC/Patho)

  • CAS. (WC/Patho)

  • CAS. (WC/Patho)

  • CAS. (WC/Patho)

Sign out

AORTIC VALVE, VALVE REPLACEMENT: 
- CALCIFIC AORTIC STENOSIS.

Micro

The sections show valve tissue with marked calcification of the fibrosa layer. No neutrophils are identified. No microorganisms are identified with routine stains.

See also

References

  1. ↑ Otto CM (September 2008). "Calcific aortic stenosis--time to look more closely at the valve". N. Engl. J. Med. 359 (13): 1395-8. doi:10.1056/NEJMe0807001. PMID 18815402.
  2. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 590. ISBN 0-7216-0187-1.
  3. ↑ Novaro, GM.; Griffin, BP. (May 2003). "Calcific aortic stenosis: another face of atherosclerosis?". Cleve Clin J Med 70 (5): 471-7. PMID 12779138.
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