Aortic stenosis

Question 1

What is aortic stenosis?

Answer 1

narrowing of LV outflow at the level of the aortic valve

Question 2

List 3 causes of AS

Answer 2

Calcification/degeneration
Rheumatic heart disease
Congenital bicuspid valve

Question 3

Give 3 epidemiological facts on AS

Answer 3

10% of > 80s
M > F
Those with bicuspid aortic valve present earlier

Question 4

What are the presenting symptoms of AS?

Answer 4

May be ASYMPTOMATIC initially
Angina (increased O2 demand of hypertrophied LV)
Exertional Syncope (due to outflow obstruction)
Symptoms of HF (e.g. dyspnoea, orthopnoea)

Question 5

Describe 7 signs of AS on examination

Answer 5

Narrow pulse pressure  
Slow-rising pulse  
Thrill in aortic area (if severe)  
Heaving undisplaced apex beat  
Ejection systolic murmur in aortic area, radiates to carotids
Soft/ absent S2 (if SEVERE)  
Ejection click (in bicuspid valve cases)

Question 6

What may be seen on ECG in AS?

Answer 6

Signs of LV hypertrophy

Signs of LV strain

Question 7

What may be seen on CXR in AS?

Answer 7

Cardiac enlargement
Post-stenotic enlargement of ascending aorta
Calcification of aortic valve

Question 8

Why perform an echocardiogram in AS?

Answer 8

Confirms presence of AS
Assesses degree of valve calcification,
Assesses LV function + wall thickness
Detects presence of other associated valve disease or aortic pathology
Provides prognostic info.

Question 9

Why perform cardioangiography in AS?

Answer 9

Allows differentiation from other causes of angina (e.g. MI)
Allows assessment of concomitant coronary artery disease