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Difference between revisions of "Calcific aortic stenosis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Aortic valve stenosis, HE 2.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. | |||
==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]]. | |||
==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]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||