View source for Calcific aortic stenosis

{{ 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]]