Bicuspid aortic stenosis electrocardiogram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Usama Talib, BSc, MD [3]

Overview

Cardiac changes such as LVH and heart block secondary to stenosis of bicuspid aortic valves may be observed on electrocardiography.

Electrocardiogram

Electrocardiogram among patients with bicuspid aortic stenosis may demonstrate features of left ventricular hypertrophy which may occur as a result of the stenosis having placed a chronically high pressure load on the left ventricle. As the left ventricular wall becomes thicker, the QRS complexes become larger. This is especially true for leads V1-V6.

The calcification process which occurs in aortic stenosis can progress to extend beyond the aortic valve and into the electrical conduction system of the heart. Evidence of this phenomenon may include heart block that is apparent on the ECG but otherwise undetectable.

ACC/AHA Guideline for EKG Evaluation and Monitoring of Asymptomatic Adolescents or Young Adults with Aortic Stenosis^[1]

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Class I

1. An ECG is recommended yearly in the asymptomatic adolescent or young adult with AS who has a Doppler mean gradient > 30 mm Hg or a peak velocity > 3.5 m per second (peak gradient > 50 mm Hg) and every 2 years if the echocardiographic Doppler mean gradient is ≤ 30 mm Hg or the peak velocity is ≤ 3.5 m per second (peak gradient less than or equal to 50 mm Hg). (Level of Evidence: C)

Class IIa

1. Graded exercise testing is a reasonable diagnostic evaluation in the adolescent or young adult with AS who has a Doppler mean gradient > 30 mm Hg or a peak velocity > 3.5 m per second (peak gradient > 50 mm Hg) if the patient is interested in athletic participation, or if the clinical ﬁndings and Doppler ﬁndings are disparate. (Level of Evidence: C)

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References

↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). “2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)

Template:WS Template:WH CME Category::Cardiology

[pmid18820172-1] Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). “2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)

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