Aortic Stenosis Flashcards
What are the causes of AS
Valvular:-
Senile calcification
Congenital deformity (bicuspid valve)
Rheumatic fever
Subvalvular AS:-
HOCM
Fibromuscular ring
Supravalvular:-
Williams syndrome
How would a patient with AS present
Usually asymptomatic
Angina - first symptom
Syncope
Breathlessness - sign of heart failure
Why does angina occur in patients with AS with normal coronary arteries
Due to the mismatch between normal coronary blood flow and a hypertrophied ventricle with increased oxygen demands
What would you expect to find on examination of a patient with AS
Ejection systolic murmur, loudest at the RSE - radiates to the carotids
Heaving apex
Soft second heart sound
Narrow pulse pressure
Slow rising and low volume pulse
Signs of left ventricular failure (bibasal creps)
What signs indicate severe AS
Soft second heart sound
Narrow pulse pressure
Delayed murmur
What would you expect to see on ECG of a patient with AS
LVH
Left axis deviation
What medications should not be used in patients with AS
Nitrates - reduce preload
ACE-I - cause vasodilatation and worsen the gradient across the valve
NO MEDICAL TREATMENT FOR AS
What are the surgical treatment options for AS
Valvuloplasty
TAVI
Open valve replacement
What is valvuloplasty
Inserting a balloon across the valve and inflating it to increase the size of the valve orifice
Doesn’t increase survival
Risk of complications
What is a TAVI
Transcatheter aortic valve implantation
Under GA
Used for patients unsuitable for open valve replacement
What are the indications for valve replacement surgery in AS
Symptomatic
Left ventricular failure if asymptomatic (mean gradient over 50)
Valve area less than 0.6
Why is angiography done on patients with AS before undergoing surgery
Aortic stenosis is associated with atherosclerotic risk factors
Any coronary artery disease should be treated at the same time as the valve replacement
What is the prognosis of AS if untreated
Asymptomatic patients have a good prognosis
Symptomatic patients have roughly 2 years
Clinical features of heart failure have a worse prognosis
How do you differentiate between aortic stenosis and sclerosis
Sclerosis:-
No radiation
Normal pulse
Normally elderly
What are the echo signs of severe AS
Valve area
Mild - over 1.5cm squared
Moderate - 1.5-1.0
Severe- less than 1.0
