Aortic stenosis

Question 1

etiology

Answer 1

depends on age :
Infants, children, adolescents:
- congenital subvalvular aortic stenosis
- congenital supravalvular aortic stenosis

Young adults to middle-aged:
- calcification & fibrosis of congenital bicuspid aortic valve
- rheumatic aortic stenosis

Middle-aged to elderly:
- senile degenerative aortic stenosis
- calcification of bicuspid valve
- rheumatic aortic stenosis
- coronary atheroma

• turbulent blood flow through congenitally abnormal aortic valves in men.
• Rheumatic fever. rheumatic heart disease
• Calcific valvular disease in the elderly.
• Arteriosclerosis, infective endocarditis.

Question 2

pathophysiology

Answer 2

slowly development (except - congenital forms):

• During systole, LV is not emptied completely because portion of blood fails to pass the narrowed aortic valve into the aorta.
• When a new normal portion of blood is delivered into LV during diastole from LA it is mixed with the residual volume & ventricle thus becomes overfilled.
• The pressure in inside LV thus rises. This cause intensification of LV work thus it hypertrophies as a compensatory mechanism. Thus diminished compliance of the hypertrophied LV wall
• hypertrophied LV muscle mass elevates myocardial O2 requirementsmay be interference with coronary blood flowischemia

Question 3

clinical picture and signs

Answer 3

• no symptoms until aortic orifice is reduced to one-third of its normal size. - At this stage, exercise-induced syncope, angina pain and dyspnoea develop. death within 2–3 years if no surgical intervention.
• Aortic face-pale.
• Giddiness, headache, tendency to faint (exertional syncope)
• acute pulmonary edema.
• peripheral cyanosis, orthopnea, severe pulmonary HT leading to RV failure and systemic venous HT, hepatomegaly, AF, and TR in severe AS

signs
Signs of pulmonary venous congestion - crepitations
Slow-rising carotid pulse
Narrow pulse pressure
Thrusting apex beat - LV pressure overload
Aortic heart configuration

Ejection systolic murmur - right 2nd interspace, Radiation: neck & down left sternal border, even to apex, harsh (at apex may be musical), Heard best with patient sitting & leaning forward