Aortic Stenosis

Question 1

What is the classical sound of aortic stenosis?

Answer 1

Crescendo-descrescendo pattern
Initially small amount of blood passes through narrow opening then when ventricular contraction reaches peak blood flows

Question 2

What are the clinical features of symptomatic disease?

Answer 2

Chest pain
Dyspnoea
Syncope
Murmur - ejection systolic murmur which radiates to the carotids and is decreased following the Valsalva manoeuvre

Question 3

What are the features with severe aortic stenosis?

Answer 3

Narrow pulse pressure and slow rising pulse

Delayed ESM

Soft or absent S2

S4
Thrill

Left ventricular hypertrophy or failure

Question 4

What is the most common cause for aortic stenosis in older patients?

Answer 4

Most common cause in older >65 years patient is degenerative calcification

Question 5

What is the most common cause in younger patients?

Answer 5

Biscupid aortic valve

Question 6

3 other causes besides calcification and biscupid aortic valve which lead to aortic stenosis

Answer 6

Wiliam’s Syndrome (supravalvular aortic stenosis)
Post-rheumatic disease

Subvalvular: HOCM

Question 7

If the aortic stenosis is asymptomatic what is the management approach?

Answer 7

Observe as general rule but if the valvular gradient is >40 mmHg with features such as left ventricular systolic dysfunction consider surgery

Question 8

What would you do if the aortic stenosis has symptoms?

Answer 8

aortic Valve replacement (AVR) , prior surgery do a angiogram

If patients are high risk then use trans catheter air

Question 9

When would you do a balloon valvulopasty instead of aortic valve replacement?

Answer 9

In children with no aortic valve calficiation or adults which are not fit for valve replacement