Aortic Stenosis

Question 1

Examination findings
(Pulse, BP, Apex, thrill/heave, auscultation)

Answer 1

Slow rising, low volume
Narrow pulse pressure
Apex beat visible in LVH
Thrill in aortic area
Cres-decres ESM in aortic area on expiration radiating to carotids

Question 2

Causes of aortic stenosis

Answer 2

Congenital bicuspid valve
Calcification degenerative
Rheumatic

Question 3

Differentials

Answer 3

Aortic Sclerosis
Pulmonary Stenosis
VSD
HOCM

Question 4

Difference with AS and PS

Answer 4

PS has normal pulse character, normal A2 and quiet P2, louder on inspiration

Question 5

How would you investigate AS?

Answer 5

Bedside: BP, pulse, temp, ECG, urine dip
Bloods: troponin, BNP, u&e, fbc, lft, CRP, coag, BCx2
Imaging: CXR, stress echo, coronary angiography

Question 6

What are the features of severe AS

Answer 6

Soft, delayed A2
Delayed ESM
S4

Question 7

Indications for surgery

Answer 7

Symptomatic or signs of Severe AS (mean gradient >40mmHg plus any of : EF<45%, low BP during exercise, VT, LVH >15mm, valve area <0.6cm*2)

Question 8

Management of AS

Answer 8

Monitor
Surgery - invasive or percutaneous/transapical
Aortic balloon valvuloplasty