Aortic Stenosis Flashcards
Q: What is aortic stenosis, and what causes it?
A: Aortic stenosis is the narrowing of the aortic valve, leading to obstructed blood flow from the left ventricle to the aorta during systole. Common causes include age-related calcific degeneration, congenital bicuspid aortic valve, and rheumatic heart disease.
Q: What is the classic murmur associated with aortic stenosis, and where is it best heard?
A: The classic murmur is a crescendo-decrescendo systolic ejection murmur best heard at the right second intercostal space (aortic area), with radiation to the carotid arteries.
Q: What are the key symptoms of severe aortic stenosis?
A: Key symptoms include angina, syncope, and heart failure (dyspnea on exertion), often remembered by the mnemonic SAD (Syncope, Angina, Dyspnea).
Q: How does aortic stenosis lead to left ventricular hypertrophy (LVH)?
A: The increased afterload caused by the narrowed aortic valve requires the left ventricle to generate higher pressure to eject blood, leading to concentric hypertrophy as the myocardium thickens to compensate.
Q: What physical examination findings might suggest severe aortic stenosis?
A: In severe aortic stenosis, you may find a delayed and weakened carotid pulse (pulsus parvus et tardus), a soft or absent second heart sound (S2), and a systolic thrill over the aortic area.
Q: What is the relationship between aortic stenosis and the “paradoxical splitting” of S2?
A: Paradoxical splitting of S2 may occur in aortic stenosis due to delayed closure of the aortic valve, causing the A2 component to occur after P2 during expiration (the opposite of normal physiological splitting).
Q: How is aortic stenosis typically diagnosed?
A: Aortic stenosis is diagnosed using echocardiography, which can assess the severity of valve narrowing, left ventricular function, and the pressure gradient across the aortic valve.
Q: What is the natural history of untreated symptomatic aortic stenosis?
A: Without treatment, symptomatic aortic stenosis carries a poor prognosis, with a high risk of sudden death once symptoms like angina, syncope, or heart failure develop.
Q: How does aortic stenosis differ from aortic sclerosis?
A: Aortic sclerosis is the thickening and calcification of the aortic valve without significant obstruction to blood flow, whereas aortic stenosis involves significant narrowing that impairs blood flow and leads to symptoms and complications.
