Bicuspid aortic stenosis electrocardiogram

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.

The above EKG changes have been described in approximately 30 percent of children with significant aortic stenosis.

==ACC/AHA Guideline for EKG Evaluation and Monitoring of Asymptomatic Adolescents or Young Adults with Aortic Stenosis == {{cquote|

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)}}