Aortic stenosis

Question 1

What is aortic stenosis?

Answer 1

Aortic valve is too small, narrow, or stiff, resulting in the obstruction of blood flow from the left ventricle to the aorta during systole.

Question 2

Aetiology of aortic stenosis?

Answer 2

Younger patients: usually from a congenital bicuspid valve.

Older patients: usually from calcifications on the aortic valve.

Question 3

Symptoms of aortic stenosis?

Answer 3

Usually no symptoms until aortic stenosis is moderately severe.

Classic triad of features is:
- Heart failure, syncope and angina (usually associated with end-stage aortic stenosis).

Question 4

Signs of aortic stenosis?

Answer 4

Ejection systolic murmur best heard at the 2nd right intercostal space right sternal edge (aortic area).

Radiates to carotids

Slow rising carotid pulse

Narrow pulse pressure

Question 5

Investigations for aortic stenosis?

Answer 5

CXR: can often show evidence of cardiomegaly and evidence of a calcified aortic valve if that is the cause.

ECG: increased QRS complex voltage, left axis deviation, poor R-wave progression.

Echocardiogram: primary test for diagnosis and evaluation of severity.

Question 6

Surgical management of aortic stenosis?

Answer 6

Surgical aortic valve replacement (SAVR): preferred management option for patients who are low risk and less than 75 years of age.

Transcatheter aortic valve implantation (TAVI): used in patients who would not tolerate an operation under anaesthesia i.e. patients with severe co-morbidities, previous heart surgery, older than 75, frailty, mobility issues etc.

Question 7

Medical management of aortic stenosis?

Answer 7

Medical therapy cannot improve the outcome of aortic stenosis, should only be used if patients are unfit for either SAVR or TAVI.

Involves standard treatment for heart failure (ACE inhibitors, beta blockers, diuretics).