Aortic stenosis

Question 1

Which anatomical structures are affected

Answer 1

Aortic valve

Question 2

What are the structural abnormalities- from birth?

Answer 2

The valve may have two cusp rather than 3

Question 3

What are the structural abnormalities - caused over lifespan?

Answer 3

Valve becomes calcified and narrowed

Question 4

Physiological abnormalities

Answer 4

The left ventricle has to generate more force to eject blood through the narrowed aortic valve–> hypertrophy

Question 5

Prior events

Answer 5

The patients are most frequently male over 65

Question 6

Symptoms

Answer 6

Angina (worse with exercise), breathlessness with exercise, lightheaded with exercise

Question 7

Clinical signs

Answer 7

Harsh and loud “ejection systolic” heart murmur- heard loudest in top RHS of chest (aortic area), reduced pulse pressure, forceful apex beat (felt LHS in midclavicular line)

Question 8

Abnormal test results

Answer 8

ECG -shows hypertrophy LV- QRS increased in size

Echocardiogram shows narrowed aortic valve + hypertrophy LV

Question 9

Medical/surgical interventions

Answer 9

If pressure difference betwen LV and aorta remains below 60mmHg- then just observation
If LV starts to dilate- surgery

Question 10

Primary and secondary prevention

Answer 10

Artificial valves –> warfarin

tissue valves –> No warfarin