تضيق الصمام الأبهري

Definition

Aortic stenosis is narrowing of the valve between the left ventricle and the aorta, so the ventricle needs higher pressure to eject blood and its walls thicken.

Causes

• Age-related calcification (most common)
• A congenital bicuspid valve
• Rheumatic fever

Symptoms

The classic triad on exertion:

• Angina
• Syncope
• Breathlessness from heart failure

Signs

• A harsh systolic murmur at the right second intercostal space radiating to the neck
• A weak, slow-rising pulse

Diagnosis

Echocardiography measures valve area and the pressure gradient.

Treatment

• Once symptomatic: valve replacement, surgical or by catheter (TAVI)
• Drugs do not treat the stenosis itself

Nursing care

• Avoid dehydration and strong vasodilators such as nitroglycerin, because output depends on adequate filling
• Teach the client to report fainting or exertional pain and to avoid strenuous effort

Exam point

Symptoms in severe stenosis mean rapid decline without valve replacement, and exertional syncope is a danger sign.