Aortic Stenosis Flashcards
Predisposed breeds.
Golden Retriever (SAS)
Boxer
Bull Terrier (valvular)
Newfoundland (SAS)
Dogue de Bordeaux
Rottweiler
Inheritance in Newfoundlands.
Autosomal dominant
PICALM gene
Inheritance in Dogue de Bordeaux.
Autosomal recessive
Grades (described in Newfoundlands).
1) mild. Small whitish nodules
2) moderate. Narrow ridge partially encircling LVOT
3) severe. Fibrous ridge, tunnel completely encircles LVOT
Historical findings.
Asymptomatic
Stunted growth
Exertional fatigue/syncope
Sudden death (1-3 years old)
L-CHF
Clinical features.
Progressive left basilar murmur (heard at thoracic inlet?)
Pulsus tardus
ECG features.
Normal
Left axis deviation
ST segment depression
T wave changes
Radiographic features.
Normal
Loss of cranial waist and widening of mediatinum (post-stenotic dilatation)
LA enlargement? (eg, MR)
Echo features.
Elevated AV VMax (subcostal)
Concentric LV hypertrophy
Obstructing lesion
Post-stenotic dilatation
Acute aorto-septal angle <145 degrees (Golden Retriever puppies)
Hyperechoic LV endocardium (ischaemia, replacement fibrosis)
Prognosis (mild AS).
Normal life
Prognosis (moderate AS).
Variable, may live normal life
Prognosis (severe AS).
Guarded long-term
Risk of sudden death, arrhythmia, endocarditis, CHF
Poor prognostic indicators.
Progressive LV sys/dias dysfunction
MR or AI
AV endocarditis
AFib
Risk of sudden death.
Severe AS
1-3 years old (1-5?)
After vigorous activity
Management of mild AS.
No treatment
Prophylactic antibiosis when anticipated bacteraemia
