Aortic stenosis

Question 1

What is pathophysiology of Aortic stenosis?

Answer 1

• Stiffening and thickening of the aortic valve - unable to fully open during systole
• Valve opening narrows - pressure gradient increases across valve

Question 2

What are the causes of Aortic stenosis

Answer 2

1. Mechanical stress / Degenerative calcification
   * Most common in older patients >65 years
   * Damaged endothelial stress - leads to fibrosis and calcification
   * Stiff valve does not open fully
2. Bicuspid aortic valve - most common younger patients
3. Rheumatic heart disease
   Repeated inflammation, fibrosis of the valve

Question 3

What are the clinical features of Aortic stenosis?

Answer 3

• Chest pain
• Dyspnea
• Syncope
• ‘Angina, syncope and exertion dyspnea’

Question 4

What is heard of auscultation of Aortic stenosis?

Answer 4

• Ejection click
• Harsh systolic murmur at upper sternal border - radiating to the carotids

Question 5

What are the clinical signs of Aortic Stenosis?

Answer 5

• Narrow pulse pressure
• Slow rising pulse

Question 6

What are the complications of Aortic Stenosis?

Answer 6

1. Heart failure secondary to Left ventricular hypertrophy and failure
2. Microangiopathic haemolytic anaemia - RBCs are damaged as they squeeze through small valve opening

Question 7

What is the gold standard investigation of Aortic stenosis?

Answer 7

• Tranthoracic echocardiogram
• ECG - non specific features of left ventricular hypertrophy

Question 8

What is the management of Aortic Stensosis?

Answer 8

1. If asymptomatic - observation
2. If symptomatic or features of left ventricular systolic dysfunction } Aortic valve replacement