Aortic Stenosis

Question 1

What is the pathology of aortic stenosis?

Answer 1

Pressure gradient between LV and aorta >50 mm Hg or aortic orifice < 1cm²

=

LV outflow obstruction

=

LV dilation, muscle hypertrophy (increased O₂ demand) and decreased stroke volume

Question 2

What is the aetiology of aortic stenosis?

Answer 2

• Degenerative calcification (most common >65y)
• Bicuspid aortic valve (most common <65y)
• Rheumatic fever
• Subvalvular HOCM

Question 3

What are the symptoms of aortic stenosis?

Answer 3

• Exertional SOB
• Angina
• Heart Failure
• Syncope
• Sudden death

Question 4

What are the clinical signs of aortic stenosis?

Answer 4

• Narrow pulse pressure
• Slow rising pulse
• Heaving apex beat
• Displaced apex beat
• Systolic thrill
• Ejection systolic murmur
  
  • Heard best over aortic valve in expiration and radiate to carotids)
• Soft S2
• S4

Question 5

What are the investigations of aortic stenosis?

Answer 5

• ECG
  
  • left ventricular hypertrophy
  • absent Q wave
  • AV block, hemiblock, BBB
• CXR
  
  • LV enlargement
  • Pulmonary congestion
• Echo
• Cardiac catheterisation

Question 6

What is the management of aortic stenosis?

Answer 6

1. Observation if asymptomatic
2. Valve replacement if symptomatic or aortic valve gradient >50mm Hg
3. Balloon valvuloplasty if not suitable for surgery