Aortic Stenosis

Question 1

What Echo Findings can you see to determine AS?

Answer 1

1. thick leaflets
2. restricted leaflet motion
3. reduced AV orifice in systole
4. aortic insufficiency
5. LVH due to pressure overload
6. LAE
7. decrease LVSF (late in course)
8. post-stenotic dilatation of ascending aorta

Question 2

Name symptoms of AS

Answer 2

1. dyspnea on exertion
2. angina
3. dizziness/syncope
4. hypotension

Question 3

What is the most common symptoms of AS?

Answer 3

dyspnea on exertion

Question 4

What would we hear on Auscultation?

Answer 4

harsh mid systolic ejection murmur

Question 5

Where is the stethoscope placed to hear auscultation?

Answer 5

right upper sternal border

Question 6

Where is Palpation done?

Answer 6

right CCA

Question 7

What is the purpose of doing a Palpation?

Answer 7

recognizes “pulsus parvus et tardus” - rises slowly and is small sustained

Question 8

How do you treat AS?

Answer 8

• AV replacement
• Medications

Question 9

How do you determine when to do AV Replacment?

Answer 9

monitor symptoms and degree of stenosis

Question 10

What treatment is definitive for AS?

Answer 10

AV Replacement

Question 11

What is AV Replacement?

Answer 11

TAVR- catheter valve replacement

Question 12

What type of antibiotics may be used?

Answer 12

prophylactic

Question 13

What type of medications may slow progression of AV?

Answer 13

controlling BP and lowering lipid drugs

Question 14

What type of medications would you give if in failure to ease failure and how would they help?

Answer 14

-diuretics to decrease volume
- beta blockers to slow rate
- nitrates to dilate coronaries

Question 15

What are the 3 etiologies (causes) of AS?

Answer 15

1. degenerative calcification of normal trileaflet
2. congenital bicuspid
3. rheumatic aortic stenosis

Question 16

When does Degenerative Calcification present?

Answer 16

occurs over many year, presents at ages 70-85

Question 17

How does Degenerative Calcification look on 2D SHORT Axis?

Answer 17

• closed AV appears very echogenic and filled with calcium that restricts the valve
• open AV is stellate shaped

Question 18

How does AS appear on M Mode?

Answer 18

AV cusps flutter when opening

Question 19

Most common cause of AS?

Answer 19

degenerative calcification

Question 20

When do symptoms of Congenital Bicuspid appear?

Answer 20

ages ~45-65

Question 21

How does Congenital Bicuspid appear on 2D SHORT AXIS?

Answer 21

valve can look normal due to raphe that takes on a football shape

Question 22

What is a raphe?

Answer 22

fusion line that is not a true separation and runs across the larger leaflet

Question 23

How does Congenital Bicuspid appear on 2D LONG AXIS?

Answer 23

dooming of leaflets into aorta in systole and diastole

Question 24

How does Congenital Bicuspid appear on M MODE?

Answer 24

may show an eccentric closure line

Question 25

When checking for stenosis in Congenital Bicuspid, what else should you look for?

Answer 25

-Aortic Insufficiency ( bicuspid always leak)
- dilation of sinuses and AR

Question 26

When is Stenosed Unicuspid seen?

Answer 26

childhood or due to restenosis after valvutomy

Question 27

What is Rheumatic Aortic Stenosis caused by?

Answer 27

untreated strep throat

Question 28

What does Rheumatic Aortic Stenosis result in?

Answer 28

commissural fusion: points/line where leaflets join

Question 29

How does Rheumatic Aortic Stenosis appear on 2D SHORT AXIS?

Answer 29

increased echogenicity along leaflet edges and commissural fusion

Question 30

How does Rheumatic Aortic Stenosis appear on 2D LONG AXIS?

Answer 30

demonstrates systolic dooming