Aortic Stenosis Prognosis

Aortic Stenosis. [Source]

The natural history of aortic stenosis (AS) in adults is characterised by a long latent period, during which there is a gradually increasing obstruction and an increase in the pressure load on the myocardium while the patient remains asymptomatic.

Once symptoms appear in patients with an unrelieved obstruction, the prognosis is poor. Survival curves have shown that the interval from the onset of symptoms to the time of death is approximately two years in patients with heart failure, three years in those with syncope and five years in those with angina. 

Before the advent of surgery, sudden cardiac death was quite common in cases of aortic stenosis (in 1968, Campbell reported that of 70 patients with aortic stenosis who died, 44 (73%) of the deaths were sudden.

Although AS may be responsible for sudden death, this usually occurs in patients who have previously been symptomatic.

Framingham Criteria for Congestive Heart Failure

Diagnosis of CHF requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.

Major criteria:

• Paroxysmal nocturnal dyspnea
• Neck vein distention
• Rales
• Radiographic cardiomegaly (increasing heart size on chest radiography)
• Acute pulmonary edema
• S3 gallop
• Increased central venous pressure (>16 cm H2O at right atrium)
• Hepatojugular reflux
• Weight loss  >4.5 kg in 5 days in response to treatment

Minor criteria:

• Bilateral ankle edema
• Nocturnal cough
• Dyspnea on ordinary exertion
• Hepatomegaly
• Pleural effusion
• Decrease in vital capacity by one third from maximum recorded
• Tachycardia (heart rate>120 beats/min.)

Minor criteria are acceptable only if they can not be attributed to another medical condition (such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome).

The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.

NYHA Functional Classification for Congestive Heart Failure

The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying heart disease (originally cardiac failure), useful for preoperative assessment. It places patients in one of four categories, based on how much they are limited during physical activity:

Class I: 

• patients with no limitation of activities; they suffer no symptoms from ordinary activities.

Class II: 

• patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion.

Class III: 

• patients with marked limitation of activity; they are comfortable only at rest.

Class IV: 

• patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest.