Diagnosis of aortic stenosis

Abstract

Aortna stenoza (AS) je opstrukcija protoka krvi kroz aortni zalistak. AS ima nekoliko etiologija, uključujući kongenitalne, degenerativne i reumatske. Simptomi AS se obično razvijaju nakon asimptomatskog latentnog razdoblja od 10-20 godina. Da bi se dijagnosticirala AS važno je pregledati povijest bolesti i simptome pacijenta te napraviti fizikalni pregled. Većina bolesnika ima klasičnu trijadu: bol u prsima, dispneju i sinkopu. Kliničari općenito ocjenjuju težinu AS-a kao blagu, umjerenu i tešku. AS se najčešće dijagnosticira kada je asimptomatska i ponekad se može otkriti tijekom rutinskog pregleda. Ključne osobine fizikalnog pregleda u bolesnika s AS su palpacija karotidnog punjenja, evaluacija sistoličkog šuma, cijepanja drugog srčanog tona te znakova srčanog zatajenja. Sistolički ejekcijski šum najbolje se čuje u drugom desnom interkostalnom prostoru; širi se prema obje karotidne arterije. Ekokardiografija je slikovna pretraga izbora za postavljanje dijagnoze, procjenu težine AS i lokalizaciju razine opstrukcije. Neke dodatne dijagnostičke pretrage, kao što su elektrokardiografija, radiografija, kateterizacija srca i angiografija, kao i napredne slikovne pretrage, mogu se provesti za dijagnosticiranje i procjenu težine AS. Zamjena aortnog zaliska protezom (AVR) je definitivna terapija za tešku AS. Prosječno očekivano trajanje života u neliječenih bolesnika sa simptomima je oko 3 godine.Aortic stenosis (AS) is the obstruction of blood flow across the aortic valve. AS has several etiologies, including congenital, degenerative and rheumatic. Symptoms of AS usually develop gradually after an asymptomatic latent period of 10-20 years. To diagnose AS it is important to review the patient's medical history and symptoms and conduct a physical examination. Most patients experience the classic triad of chest pain, dyspnea, and syncope. Clinicians generally grade the severity of AS as mild, moderate and severe. AS is most often diagnosed when it is asymptomatic and can sometimes be detected during routine examination. The key features of the physical examination in patients with AS are palpation of the carotid upstroke, evaluation of the systolic murmur, splitting of the second heart sound, and signs of heart failure. Systolic ejection murmur is heard loudest at the 2nd right intercostal space; it radiates to the carotid arteries bilaterally. Echocardiography is the imaging modality of choice to set a diagnosis, estimate the severity of AS, and localize the level of obstruction. Some additional diagnostic modalities, such as electrocardiography, radiography, cardiac catheterization, and angiography as well as advanced imaging modalites, can be preformed to diagnose and evaluate the severity of AS. Aortic valve replacement (AVR) is the definitive therapy for severe AS. The average life expectancy in untreated patients with symptoms is approximately 3 years