aortic stenosis Flashcards

1
Q

what is normal aortic valve size

A

3-4cm2

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2
Q

when do symptoms of aortic stenosis

A

when valve area is ¼ of normal

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3
Q

3 types of aortic stenosis

A

Supravalvular – above valve
Subvalvular – below valve
Valvular – most common

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4
Q

pathology of aortic stenosis

A
  1. narrow valve means obstructed LV emptying
  2. pressure gradient develops between the LV and aorta
  3. increased afterload 🡪 LV hypertrophy
  4. results in:
    - increased myocardial oxygen demand
    - relative ischaemia of the myocardium and consequent angina - arrhythmias
    - LV failure
  5. LV systolic function is typically preserved in aortic stenosis
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5
Q

3 causes of aortic stenosis

A
  1. Calcification of congenital bicuspid aortic valve (BAV) – most common and presents in middle age
  2. Degeneration and calcification of a normal valve – presents in elderly
  3. Rheumatic heart disease
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6
Q

risk factors of aortic stenosis

A

Congenital BAV – predisposed to stenosis and regurgitation

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7
Q

when should you always suspect aortic stenosis

A

in ANY elderly person with chest pain, exertional dyspnoea or syncope

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8
Q

symptoms of aortic stenosis

A
  1. Classic triad
    - Exertional syncope
    - Angina
    - Dyspnoea – due to HF
  2. Heart failure
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9
Q

signs of aortic stenosis

A

Slow rising (pulsus tardus) and weak (pulsus parvus) carotid pulse

Heart sounds
- Soft or absent 2nd heart sound – may become soft or inaudible when the valve becomes immobile
- Prominent 4th heart sound – due to LV hypertrophy
- Ejection systolic murmur – crescendo – decrescendo character

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10
Q

4 investigations for aortic stenosis

A
  1. Echocardiography (diagnostic)
  2. chest X ray
  3. ECG
  4. Cardiac catheterisation
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11
Q

what does chest x ray of aortic stenosis show

A

shows a normal heart size, LVH, prominence of the ascending aorta (post-stenotic dilatation) and there may be valvular calcification

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12
Q

what does ECG of aortic stenosis show

A

Shows evidence of LVH and a LV stress pattern when disease is severe

ST depression and T-wave inversion in aVL, V5 and V6

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13
Q

why is cardiac catheterisation done

A

used to exclude coronary artery disease

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14
Q

surgical management of aortic stenosis

A

Aortic valve replacement – in symptomatic patients as onset of symptoms associated with 75% mortality at 3 years

If not medically fit for surgery, then Transcatheter Aortic Valve Implantation (TAVI) with a balloon expandable stent

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15
Q

general management of aoritc stenosis

A

Dental hygiene/care – risk of infective endocarditis

IE prophylaxis in dental procedures

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16
Q
A