Aortic stenosis

Question 1

Pathophysiology

Answer 1

Narrowing of Aortic valve

Question 2

Causes

Answer 2

Age related calcification
Congenital bicuspid valve
Rheumatic fever
CKD

Question 3

Symptoms

Answer 3

Syncope
Dyspnoea
Angina
Reduced exercise tolerance

Question 4

Examination finding causes

Answer 4

Tar staining, xanthoma, corneal arcus, xanthelasma
Rash, enlarged tonsils, fever
Peripheral odema

Question 5

Examination findings pulse

Answer 5

Slow rising pulse
Narrow pulse pressure

Question 6

Examination findings palpation

Answer 6

Thrill in aortic region (2nd IC Right)
Displaced aepx beat

Question 7

Examination findings auscultaion

Answer 7

Ejection systolic cresendo-decresendo murmur radaiting to carotids.

Question 8

Examination findings complications

Answer 8

Elevated JVP (>3cm) (IJV located between sternal and clavicular head of SCM)
Displaced apex beat
Bibasal crackles
Sacral odema
Peripheral odema

Question 9

Severity

Answer 9

Healthy - 3.0+
Mild - 1.2 - 3.0
Moderate - 1.0 - 1.2
Severe - <1.0

Question 10

Treatment

Answer 10

Surgical valve replacement (<65 Yrs)
TAVI via Femoral A ( >65 Yrs / Co-morbid)
Baloon Valvuloplasty (Children/ Unfit for surgery)

Question 11

Indications for surgery

Answer 11

Symptomatic
Asymptomatic with signs of LVD
Asymptomatic with abnormal exercise test
Asymptomatic at time of other cardiac surgery (CABG)

Question 12

Investigations

Answer 12

ECG for LVD
Echo to confirm diagnosis
Angiogram for co-existing CAD