Aortic stenosis

Question 1

Causes?

Answer 1

1. bicuspid aortic valve
2. degenerative calcification
3. Rheumatic heart disease
4. Congenital
5. IE

Question 2

Characteristics of murmur

Answer 2

Ejection systolic, loudest in the aortic area, louder on expiration, radiates to the carotids

Question 3

Clinical signs of severity

Answer 3

1. Low volume, slow rising pulse with narrow pulse pressure
2. Reversed splitting of the second heart sound
3. Soft aortic component of the second heart sound
4. Signs of pulmonary hypertension
5. Signs of pulmonary congestion

Question 4

ECHO findings in severe AS

Answer 4

1. Valve area <1.0cm2
2. Vmax (peak transvalvular velocity) >4.0m/s
3. Mean pressure gradient >40mmHg

Question 5

Indications for valve replacement

Answer 5

1. Severe AS with symptoms
2. Moderate/severe AS undergoing cardiac surgery
3. Severe AS and LVSD/abnormal BP in response to exercise, VT, valve area <0.6cm2

Question 6

TAVI or surgical valve replacement

Answer 6

TAVI in >75yo or unsuitable/high risk for surgical valve replacement

Question 7

Complications of AS

Answer 7

LVF
Sudden death
Pulmonary hypertension
Arrhythmias
Heart block
IE
Systemic embolic complications
Haemolytic anaemia

Question 8

Differential diagnoses for ejection systolic murmur, louder on expiration

Answer 8

Aortic stenosis, HOCM, supravalvular aortic stenosis