Aortic stenosis

Question 1

What is the normal area of a healthy aortic valve?

Answer 1

3-4cm2

Question 2

Symptoms start when the aortic valve is ___% its normal lumen size

Answer 2

25%

Question 3

True or false: aortic stenosis is the most common valve disorder

Answer 3

True

Question 4

Aortic stenosis results in left ventricular ____ and ______

Answer 4

dilation and hypertrophy

Question 5

Is the aortic valve normally bicuspid or tricuspid?

Answer 5

Tricuspid

Question 6

What causes aortic stenosis?

Answer 6

Ageing calcification
Congenital bicuspid valve

Question 7

What are symptoms of aortic stenosis?

Answer 7

SAD:
Syncope (exertional)
Angina
Dyspnoea (related to HF)

Question 8

Describe the murmur hear with aortic stenosis

Answer 8

Ejection systolic crescendo decrescendo murmur radiating to the carotids

Question 9

Where is an aortic stenosis murmur heard best?

Answer 9

Right sternal border, 2nd intercostal space

Question 10

Describe the heart sounds in aortic stenosis

Answer 10

Normal S1
Ejection systolic crescendo-decrescendo murmur

S2 (may be paradoxically split due to increased ejection time and LV pressure)

Prominent S4 in severe aortic stenosis due to LV hypertrophy making it non-compliant so sound as blood pushed into LV from LA.

NB: paradoxically split is about timing of pulmonary valve to aortic valve closure. In aortic stenosis, pulmonary valve closes before aortic valve. Normally other way round.

Question 11

What does pulse pressure refer to?

Answer 11

The difference between systolic and diastolic blood pressure measurements.

Pulse pressure = Systolic pressure-diastolic blood pressure

Question 12

True of false: in aortic stenosis there is a wide pulse pressure

Answer 12

False

Narrow aortic valve limits ejection of blood during systole so lower systolic blood pressure. Increased LV pressure also leads to reduced diastolic filling so higher diastolic bp therefore difference between systolic and diastolic bp is narrow.

Question 13

True or false: in aortic stenosis there is a slow rising pulse

Answer 13

Less sharp upstroke of arterial pressure reflecting the prolonged ejection of blood into aorta during systole due to narrow valve.

Question 14

How is aortic stenosis diagnosed?

Answer 14

ECG
CXR
Gold standard = ECHO showing LV size and function. If Doppler derived shows aortic valve area

Question 15

How is aortic stenosis treated?

Answer 15

If symptomatic, surgical:

Open repair. valve replacement if healthy

If patient more at risk (aged 75+) then TAVI

Question 16

What is TAVI?

Answer 16

Transcutaneous Aortic Valve Implant

Is less invasive, stents valve open.

Question 17

Other than aortic stenosis, what else may cause an S4 sound?

Answer 17

Hypertrophic cardiomyopathy
The hypertrophy makes the LV less compliant so sound heard at blood hits the ventricle wall post atrial contraction.

(associated with sudden death in men)