Aortic Stenosis

Question 1

What are the aetiologies of aortic stenosis?

Answer 1

Degenerative
Rheumatic
Congenital abnormalities

Question 2

What is the pathophysiology of aortic stenosis?

Answer 2

obstructed left ventricular emptying leads to increased left ventricular pressure and compensatory left ventricular hypertrophy
This results in relative ischaemia and consequent angina, arrhythmias and left ventricular failure
Cardiac output can hardly increase causing blood pressure to fall, coronary ischaemia to worsen, myocardium fails and cardiac arrhythmias develop or worsen
Left ventricular systolic function is generally preserved

Question 3

What are the symptoms of aortic stenosis?

Answer 3

Usually no symptoms until moderately severe
Exercise induced syncope
Angina
Dyspnoea

Question 4

What are the signs of aortic stenosis?

Answer 4

carotid pulse is small volume and slow rising, sinus rhythm
Apex not displaced, pulsation sustained
Soft S2, A2, S4
Systolic murmur radiating to carotids

Question 5

What are the investigations for aortic stenosis?

Answer 5

CHEST XRAY - relatively small heart, prominent ascending aorta, aortic valve calcified, CTR increased in hf
ELECTROCARDIOGRAM - left ventricular hypertrophy and delay, depressed ST and T wave inversion in leads 1 AVL, V5, V6, sinus rhythm
ECHOCARDIOGRAM - thickened, calcified and immobile aortic valve cusps. LVH, assessment of pressure gradient
CARDIAC CATHETERISATION - document systolic pressure difference between aorta and LV, assess LV function

Question 6

What is the treatment of aortic stenosis?

Answer 6

Valve replacement in all symptomatic patients
Regular review of known asymptomatic patients
Valvotomy or balloon dilation in childhood/adolescence