Aortic Stenosis

Question 1

where is the aortic valve auscultated

Answer 1

in the right upper sternal border; right sternal border at the 2nd intercostal space

Question 2

what is aortic stenosis

Answer 2

progressive narrowing of the aorta causing obstruction of blood flow through the aortic valve

Question 3

what causes the narrowing and obstruction of the aortic valve

Answer 3

aortic valve fibrosis and calcification

Question 4

aetiology of aortic stenosis (greatest cause)

Answer 4

congenital bicuspid aortic valve calcification is the greatest cause

Question 5

other causes of aortic stenosis

Answer 5

stenosis can be secondary to rheumatic heart disease.

it can also be due to calcification and degeneration of tricuspid aortic valve in the elderly

Question 6

risk factors of aortic stenosis

Answer 6

age above 60 yrs
congenital bicuspid aortic valve
rheumatic heart disease
chronic kidney disease (calcium levels)
radiotherapy

Question 7

what is bicuspid aortic valve

Answer 7

the aortic valve usually has 3 leaflets, in congenital BAC, there are only 2

Question 8

epidemiology of aortic stenosis

Answer 8

presents in 3% of people aged 75 and above

more common in males

those with BAV will present with it earlier

Question 9

presenting symptoms of aortic stenosis

Answer 9

may initially be asymptomatic, extertional dyspnoea (breathlessness on exercise), angina, syncope or dizziness, fatigue

Question 10

why can someone present with angina

Answer 10

hypertrophic left ventricle

Question 11

why may someone present with syncope or dizziness

Answer 11

outflow obstruction

Question 12

why may someone present with fatigue

Answer 12

less O2 reaching tissues and muscles, less aerobic respiration and therefore less ATP generation

Question 13

signs upon physical examination

Answer 13

ejection systolic murmur in the aortic region, S2 will be diminished- it will either be softened or absent, narrow pulse pressure, thrill in aortic area and forceful sustained thrusting undisplaced apex beat

Question 14

what nature is the murmur

Answer 14

crescendo-descrendo

Question 15

what investigations will be done

Answer 15

Transthoracic echocardiogram
ECG
chest XRay
cardiac angiography

Question 16

what ECG findings are most common

Answer 16

mostly present with LVH abnormalities; deep S wave in V1/2, tall R in V5/6 and T inversion in lead I, aVL and V5/6

Question 17

What other diseases can manifest on an ECG in someone with aortic stenosis

Answer 17

Patients with AS can often have conduction disease manifesting as atrioventricular block, hemiblock, or bundle branch block

Question 18

initial treatment

Answer 18

medical therapy or balloon valvuloplasty

Question 19

acute treatment

Answer 19

surgical/ trans catheter valve replacement

with long term infective endocarditis antibiotic prophylaxis, long term anticoagulation and medical therapy

Question 20

what else will be given to someone that’s had surgical/transcatheter replacement of the aortic valve

Answer 20

long term infective endocarditis antibiotic prophylaxis, long term anticoagulation and medical therapy

Question 21

what does medical therapy include

Answer 21

Medical therapy for hypertension and hyperlipidaemia is appropriate in patients with AS and hypertension and/or coronary artery disease

Statin therapy is indicated for primary and secondary prevention of atherosclerosis in all patients with calcific AS on the basis of standard risk scores

In patients who have undergone TAVR, renin–angiotensin system blocker therapy (ACE inhibitor or angiotensin receptor blocker) may be considered to reduce the long-term risk of all-cause mortality