Aortic Regurgitation + Stenosis

Question 1

What is the definition of aortic stenosis?

Answer 1

Normal area 3-4cm2
Sx at 1/4 lumen size (<1cm2)
MC - valve disorder - Results in LV dilation + hypertrophy

Question 2

Causes of aortic stenosis

Answer 2

Ageing calcification
Also congenital bicuspid valve (2 leaflets instead of 3) - normally tricuspid
Congenital aortic stenosis

Question 3

Symptoms of aortic stenosis

Answer 3

SAD - syncope (exertional), Angina, Dyspnoea (related to heart failure)

Question 4

What type of murmur is seen in aortic stenosis?

Answer 4

Ejection systolic crescendo Decresendo, radiating to carotids at right sternal border, 2nd IC space

Prominent S4 - seen in LVH
Narrow pulse pressure + slow rising pulse (not collapsing comgan pulse)

Slow rising carotid pulse (pulses tardus)
Low Volume (pulsus parvus)

Question 5

Diagnosis of Aortic stenosis

Answer 5

ECG
Chest X ray
GS = ECHO - LV function + size , Aortic Valve area (doppler derived)

Question 6

Treatment for aortic stenosis

Answer 6

General - dental hygiene/care - prevent IE
Surgical if Sx - healthy Px = open repair/valve replaced (DEFINITIVE)
More at risk (eg. 75+) = TAVI (transcatheter aortic valve implantation) - less invasive just stents valve open

Question 7

Definition of Aortic regurgitation

Answer 7

Leaky aortic valve, insufficiency (blood leaks from aorta back to LV)

Question 8

Causes of aortic regurgitation

Answer 8

Congenital bicuspid valve
RHD
Connective tissue disorder (M & ED)
IE

Question 9

Symptoms of Aortic regurgitation
What type of murmur

Answer 9

Early Diastolic Blowing Murmur at right sternal border, 2nd IC space

Austin flint murmur - severe- Mid diastolic low pitched rumble, headed when regurgitation so severe blood bounces off mitral valve cusps + makes sound

Collapsing common pulse with wide pulse pressure

Quincke (nail bed pulses when pressed) + De Musset (head bobbing signs)

Question 10

Diagnosis of aortic regurgitation

Answer 10

ECG
Chest X ray
GS - ECHO = evaluate aortic valve, root + dimentous

Question 11

Diagnosis of aortic regurgitation

Answer 11

ECG
Chest X ray
GS - ECHO = evaluate aortic valve, root + dimentous

Question 12

Treatment for Aortic regurgitation

Answer 12

Consider IE prophylaxis (consider this as DDx)
Surgical valve replacement if Sx