Aortic sclerosis
Aortic sclerosis is calcific thickening of the aortic valve without significant obstruction, producing a systolic murmur but no meaningful gradient. It shares risk factors with atherosclerosis, is a marker of cardiovascular risk, and can progress to aortic stenosis, so management is cardiovascular risk-factor control and echocardiographic surveillance.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: aortic sclerosis is calcific thickening and stiffening of the aortic valve leaflets without significant obstruction to outflow (peak jet velocity under 2.5 m/s).
- Epidemiology
Very common in older adults, increasing steeply with age.
- Risk factors
Age. Atherosclerotic risk factors: hypertension, hyperlipidemia, smoking, and diabetes.
- Pathophysiology
An active, atherosclerosis-like process: lipid deposition, inflammation, and calcification thicken the leaflets.
- Clinical features
Asymptomatic, an incidental finding. A systolic ejection murmur at the base, usually grade 1 to 2.
- Differential diagnosis
Aortic stenosis: an ejection murmur with a significant gradient, distinguished by a delayed carotid upstroke, soft or absent second heart sound, and a peak jet velocity at or above 2.5 m/s, unlike…
- Diagnosis
Establish by echocardiography showing leaflet thickening and calcification with a peak jet velocity below 2.5 m/s and no significant gradient: the diagnostic basis is transthoracic echocardiography…
- Management
First-line, control atherosclerotic risk factors: treat hypertension (target below 130/80 mmHg, for example amlodipine 5 to 10 mg PO daily), and address diabetes and smoking cessation, continued long term.
- Complications
Progression to aortic stenosis in a minority.
- Prognosis
Benign from the valve itself while obstruction is absent.
- Prevention
Control blood pressure below 130/80 mmHg.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Aortic stenosis
Aortic stenosis is obstruction to left ventricular outflow from a narrowed aortic valve, most often calcific degeneration in older adults or a bicentric bicuspid valve earlier in life. Symptoms of angina, syncope, or heart failure mark a poor prognosis, and severe symptomatic disease is treated with valve replacement (surgical or transcatheter).
- Atherosclerosis
Atherosclerosis is a chronic inflammatory, lipid-driven disease of the arterial wall in which plaques narrow arteries and can rupture to cause acute thrombosis. It underlies coronary, cerebrovascular, and peripheral artery disease, and management is aggressive risk-factor control, high-intensity statins, and antiplatelet therapy, with revascularization for specific lesions.
- Dyslipidemia
Dyslipidemia is an abnormal lipid profile, chiefly elevated LDL cholesterol, that drives atherosclerotic cardiovascular disease. Management is risk-based LDL lowering with statins as the foundation, adding ezetimibe and PCSK9 inhibitors to reach targets, alongside lifestyle change and evaluation for severe genetic forms and hypertriglyceridemia.
- Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is an autosomal dominant sarcomere disease causing unexplained left ventricular hypertrophy, often with dynamic left ventricular outflow tract obstruction, and is a leading cause of sudden cardiac death in young people. Diagnosis is by echocardiography or cardiac MRI showing unexplained hypertrophy, and management includes negative inotropes, obstruction relief, and ICD placement for high sudden-death risk.
- Mitral regurgitation
Mitral regurgitation is systolic backflow from the left ventricle into the left atrium, classified as primary (valve disease) or secondary (ventricular or annular disease). Chronic disease causes volume overload with an apical holosystolic murmur, while acute severe regurgitation causes pulmonary edema; severe primary disease is treated with valve repair or replacement.
- Pulmonic stenosis
Pulmonic stenosis is obstruction to right ventricular outflow from a narrowed pulmonary valve, usually congenital. It causes a systolic ejection murmur with an ejection click and, when severe, right ventricular hypertrophy and failure; severe or symptomatic disease is treated effectively with balloon valvuloplasty.