aortic stenosis Flashcards
what is normal aortic valve size
3-4cm2
when do symptoms of aortic stenosis
when valve area is ¼ of normal
3 types of aortic stenosis
Supravalvular – above valve
Subvalvular – below valve
Valvular – most common
pathology of aortic stenosis
- narrow valve means obstructed LV emptying
- pressure gradient develops between the LV and aorta
- increased afterload 🡪 LV hypertrophy
- results in:
- increased myocardial oxygen demand
- relative ischaemia of the myocardium and consequent angina - arrhythmias
- LV failure - LV systolic function is typically preserved in aortic stenosis
3 causes of aortic stenosis
- Calcification of congenital bicuspid aortic valve (BAV) – most common and presents in middle age
- Degeneration and calcification of a normal valve – presents in elderly
- Rheumatic heart disease
risk factors of aortic stenosis
Congenital BAV – predisposed to stenosis and regurgitation
when should you always suspect aortic stenosis
in ANY elderly person with chest pain, exertional dyspnoea or syncope
symptoms of aortic stenosis
- Classic triad
- Exertional syncope
- Angina
- Dyspnoea – due to HF - Heart failure
signs of aortic stenosis
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
4 investigations for aortic stenosis
- Echocardiography (diagnostic)
- chest X ray
- ECG
- Cardiac catheterisation
what does chest x ray of aortic stenosis show
shows a normal heart size, LVH, prominence of the ascending aorta (post-stenotic dilatation) and there may be valvular calcification
what does ECG of aortic stenosis show
Shows evidence of LVH and a LV stress pattern when disease is severe
ST depression and T-wave inversion in aVL, V5 and V6
why is cardiac catheterisation done
used to exclude coronary artery disease
surgical management of aortic stenosis
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
general management of aoritc stenosis
Dental hygiene/care – risk of infective endocarditis
IE prophylaxis in dental procedures