Systolic murmur in an asymptomatic 70 year old man
P Paramsothy, CM Otto, Division of Cardiology, University of Washington, Seattle, USA Correspondence to: Professor Catherine
M Otto; cmotto{at}u.washington.edu
A 70 year old man with hypertension underwent echocardiography for an asymptomatic murmur and was found to have aortic valve
sclerosis. Over the next eight years, annual echocardiography showed progressive valve calcification with an increase in transaortic
velocity and pressure gradient and a decrease in valve area. He eventually developed decreased exercise tolerance and was
referred for aortic valve replacement.
The purpose of this interactive case presentation is to illustrate the diagnosis and clinical implications of aortic valve
sclerosis and the progression of sclerosis to significant stenosis, and its appropriate diagnosis and management.
The purpose of this interactive case presentation is to illustrate:
-
The clinical significance of aortic valve sclerosis
-
The clinical factors associated with aortic valve sclerosis
-
The diagnosis of aortic valve stenosis
-
The natural history of aortic stenosis
-
The physical signs and echo cardiographic features of severe aortic stenosis
This interactive case history is hosted on BMJ Learning—the best available learning website for medical professionals from
The BMJ Group.
To access the interactive case, please use [Take this module on BMJ Learning] link from the online article content box or table of contents.
REFERENCES
-
Otto C M. Why is aortic sclerosis associated with adverse clinical outcomes? J Am Coll Cardiol2004;43:176-7.
-
Stewart B F, Siscovick D , Lind B K, et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol1997;29:630-4.
-
Otto C M, Lind B K, Kitzman D W, et al. Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med1999;341:142-7.
-
Otto C M, Kuusisto J , Reichenbach D D, et al. Characterization of the early lesion of degenerative valvular aortic stenosis. Circulation1994;90:844-53.
-
Chandra H R, Goldstein J A, Choudhary N , et al. Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation. J Am Coll Cardiol2004;43:169-75.
-
Olsson M , Thyberg J , Nilsson J . Presence of oxidized low density lipoprotein in nonrheumatic stenotic aortic vales. Aterioscler Thromb Vasc Biol1999;19:1218-22.
-
O'Brien K D, Shavelle D M, Caulfield M T, et al. Association of angiotensin-converting enzyme with low-density lipoprotein in aortic valvular lesions and in human plasma.
Circulation2002;106:2224-30.
-
Rajamannan N M, Subramaniam M , Rickard D , et al. Human aortic valve calcification is associated with an osteoblast phenotype. Circulation2003;107:2181-4.
-
Novaro G M, Sachar R , Pearce G L, et al. Association between apolipoprotein e alleles and calcific valvular disease. Circulation2003;108:1804-8.
-
Ortlepp J R, Hoffmann R , Ohme F , et al. The vitamin D receptor genotype predisposes to the development of calcific aortic valve stenosis. Heart2001;85:635-8.
-
Agmon Y . Khandheria BK. Aortic valve sclerosis and aortic atherosclerosis: different manifestation so the same disease, J Am Coll Cardiol2001;38:827-34.
-
Poggianti E , Venneri L . Aortic valve sclerosis is associated with systemic endothelial dysfunction. J Am Coll Cardiol2003;41:136-41.
-
Munt B , Legget M E, Kraft C D, et al. Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome.
Am Heart J1999;137:298-306.
-
Faggiano P , Antonini-Canterin F , Erlicher A , et al. Progression of aortic valve sclerosis to aortic stenosis. Am J Cardiol2003;91:99-101.
-
Cosmi J E, Kort S , Tunick P A, et al. The risk of the development of aortic stenosis in patients with "benign" aortic valve thickening. Arch Intern Med2002;162:2345-7.
-
Otto C M, Burwash I G, Legget M E, et al. Prospective study of asymptomatic valvular aortic stenosis. Circulation1997;95:2262-70.
-
Rosenhek R , Binder T , Porenta G , et al. Predictors of outcome in severe, asymptomatic aortic stenosis. 2000;343:611-17.
-
Rosenhek R , Klaar U , Schemper M , et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur Heart J2004;25:199-205.
-
Carabello B A. Clinical practice: aortic stenosis. N Engl J Med2002;346:677-82.
-
Berlger-Klein J , Klaar U , Heger M , et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation2004;109:2302-8.
-
Gerber I L, Stewart R A H, Legget M E, et al. Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis. Circulation2003;107:1884-90.
-
Novaro G M, Tiong I Y, Pearce G L, et al. Effect of hydroxymethyl-glutaryl coenzyme reductase inhibitors on the progression of calcific aortic stenosis. Circulation2001;104:2205-9.
-
Bellamy M F, Pellikka P A, Klarich K W, et al. Association of cholesterol levels, hydroxymethyl-glutaryl coenzyme-A reductase inhibitor treatment, and progression of aortic
stenosis in the community. J Am Coll Cardiol2002;40:1723-30.
-
Pohle K , Maffert R , Ropers D , et al. Progression of aortic valve calcification: association with coronary atherosclerosis and cardiovascular risk factors. Circulation2001;104:1927-32.
-
Shavelle D M, Takasu J , Budoff M J, et al. HMG CoA reductase inhibitor (statin) and aortic valve calcium. Lancet2002;359:1125-6.
