An overview of aortic stenosis (AS): what we know and when should we intervene?

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Rudaina I. Osman
Hassan I. Osman
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International Journal of Research
Introduction: A condition in which there is a continuous state of fibrosis, thickening as well as calcification of the leaflets that’ll eventually impede the amount of blood reaching the heart, which, if left untreated/maltreated, will eventually lead to death (1). AS does not only have an impact on the aforementioned valve, but on the LV and the entirety of the systemic vasculature (2). The most commonly encountered heart valve lesion, AS is believed to affect 2- 5% of older adults (3). It is estimated that 4-7% of individuals aged 65 years or older have been diagnosed with severe AS (3). Etiology of AS: It is believed that there are 3 major causes of AS, these are: 1) Degenerative (Calcific), 2) Rheumatic (4,5), and 3) Congenital Clinical Manifestations & Underlying Etiology: First articulated in 1968 by Ross and Braunwald (8), it is now commonly accepted amongst professionals that the development of symptoms (such as exertional dyspnea, angina, and syncope) is a poor prognostic sign as it clearly signifies left ventricular decompensation (1,8). Diagnosis: The diagnosis of calcific aortic stenosis is initially suspected if a systolic ejection murmur is present; be that as it may, the clinically significant question is normally whether the aortic stenosis is to be classified as ‘severe’ (5). The three most useful signs when it comes to diagnosing severe aortic stenosis are: 1) Late peaking systolic murmur, 2) Single second heart sound or paradoxical splitting of S2, and 3) ‘cooing’ murmur (5). Current guideline-recommended treatment strategies and their limitations: In a general sense, contemporary clinical rules suggest aortic valve intervention when stenosis seriousness is considered extreme and there is confirmation of left ventricular decompensation, via the direct even-handed or proxy representative measures (1). Conclusion: Aortic stenosis is a common cardiac disease that is of the upmost importance, deserves our undivided attention, and a crucial part in decreasing any morbidity and mortality is generally through a very careful follow-up. The gold standard investigation for suspected cases is echocardiography (5), currently the only treatment available would be a valve replacement therapy which is proven to have a good outcome and increases the patient’s life span (4). In asymptomatic patients on the other hand aortic valve replacement is considered only after symptoms have developed or if the exercise test results are worrying (4,14). We are hoping that in the future there’ll be more treatment options available that would suit the different ages and health statuses of the patients. Recommendations: 1) The initiation, funding, and publication of further studies on AS, ergo permitting for decreased morbidity and mortality, 2)The initiation of awareness programs amongst the public that would result in a decreased likelihood of lifestyle-caused AS, 3) The initiation of awareness programs amongst the public that would result in patients being overall better surgical candidates if it must take place, 4) The initiation of nation-wide (in Sudan and elsewhere around the world) geriatric services that would result in the monitoring of those most likely to fall ill with AS.
Osman, R.I. and Osman, H.I., 2021. An overview of aortic stenosis (AS): what we know and when should we intervene?. An overview of aortic stenosis (AS): what we know and when should we intervene?, 77(1), pp.9-9.