Aortic Stenosis

Question 1

2 characteristics of unicuspid aortic valve

Answer 1

• causes severe obstruction to left ventricular outflow in infancy
• most common cause of fatal valvular aortic stenosis in infancy

Question 2

characteristics of bicuspid aortic valve

Answer 2

• 4:1 male to female
• often not detected until adulthood
• may be associated with dilatation of aortic root

Question 3

age related variation in etiology of AS

Answer 3

• < 65 years, most are congenital

- > 65 years, most are acquired

Question 4

3 classic symptoms of AS

Answer 4

• angina
• syncope
• CHF symptoms (SOB, unable to lay flat and breathe normally, SOB wakes up at night)

Question 5

natural history of AS

Answer 5

• relatively long asymptomatic period
• once symptoms develop, mortality increases dramatically
• life expectancy without surgery depends on presenting symptom

Question 6

presenting symptoms and life expectancy

Answer 6

• angina - 5 years
• syncope - 3 years
• CHF symptoms - 2 years

Question 7

ausculatory findings for AS

Answer 7

• systolic ejection murmur that radiates to the neck
• pulsus parvus et tardus - delayed and diminished carotid upstroke
• crescendo-decrescendo
• systolic ejection click if its caused by bicuscpid valve
• S4, diminished or absent A2, paradoxical splitting of S2

Question 8

EKG findings for AS

Answer 8

• LVH

- sinus rhythm - if atrial fibrillation, consider concomitant mitral valve disease

Question 9

CXR findings for AS

Answer 9

• LV prominence
• dilatation of the ascending aorta
• calcification of the aortic valve

Question 10

gold standard to diagnosis

Answer 10

• echo

Question 11

imaging modality done before almost every valve replacement surgeries

Answer 11

• cardiac cath

Question 12

medical therapy for AS

Answer 12

• not definitive
• heart rate control
• symptomatic treatment but use caution with nitrates, diuretics, and vasodilators because of reflex tachycardia

Question 13

surgical therapy for AS

Answer 13

• only definitive treatment

- indications include symptomatic severe AS or severe AS with LV systolic dysfunction (LVEF < 50%)

Question 14

balloon aortic valvuloplasty therapy for AS

Answer 14

• used as a last resort
• high restenosis rate
• indicated to bridge AVR or for emergency non-cardiac surgery