Aortic Stenosis

Question 1

What is aortic stenosis.

Answer 1

A pressure gradient between the LV and aorta >50mmHg or aortic orifice

Question 2

What is the heart’s response to aortic stenosis. (3)

Answer 2

LV dilatation.
LV muscle hypertrophy.
Decreased stroke volume.

Question 3

What is in increased demand in aortic stenosis.

Answer 3

Oxygen.

Question 4

What are the causes of aortic stenosis. (3)

Answer 4

Senile calcification of the valve is the commonest cause.
Rheumatic fever.
Congenital(William’s syndrome, bicuspid valve).

Question 5

What are the symptoms of aortic stenosis. (9)

Answer 5

Exertional dyspnoea. 
Angina. 
Heart failure (usually after 60). 
Syncope.  
Sudden death. 
Dyspnoea. 
Dizziness. 
Faints. 
Systemic emboli if infective endocarditis.

Question 6

What are the clinical signs of aortic stenosis. (9)

Answer 6

Narrow pulse pressure. 
Slow rising pulse. 
Heaving, non-displaced apex beat. 
Systolic thrill. 
LV heave. 
Aortic thrill. 
Ejection systolic murmur (heard best over the aortic valve in expiration and it may radiate to the carotids). 
Soft S2 (normal S1). . 
Paradoxical splitting of S2.
4th heart sound.

Question 7

What is seen on the ECG of a patient with aortic stenosis. (4)

Answer 7

LV hypertrophy and strain.
P-mirale.
Poor R wave progression.
LBBB or complete AV blok.

Question 8

What is the differential for a patient with aortic stenosis. (3)

Answer 8

Aortic stenosis.
Hypertrophic cardiomyopathy.
Ischaemic heart disease.

Question 9

What is seen on the CXR of a patient with aortic stenosis. (3)

Answer 9

LVH.
Calcified aortic valve.
Post-stenotic dilatation of ascending aorta.

Question 10

What is the most diagnostic test for AS.

Answer 10

Echo.