Aortic Stenosis

Question 1

what is the definition of aortic stenosis

Answer 1

narrowing of LV outflow at level of aortic valve

Question 2

what is the aetiology of aortic stenosis

Answer 2

1 calcification/degeneration or normal aortic valve in elderly (commonest)
2 calcification of bicuspid aortic valve
3 stenosis secondary to rheumatic heart disease

Question 3

what is the epidemiology of aortic stenosis

Answer 3

elderly
males>females
those with bicuspid aortic valve present earlier

Question 4

what history is associated with aortic stenosis

Answer 4

initially asymptomatic
SAD
Syncope (reduced blood supply to the brain)
Angina (reduced blood supply to the myocardium)
Dyspnoea

symptoms of LHF

Question 5

what are the examination findings in aortic stenosis

Answer 5

1. narrow PP and slow-rising pulse
2. thrill in aortic region if severe
3. harsh ejection systolic murmur loudest in aortic area
4. radiation of murmur to carotids
5. quiet/absent HS2 due to calcification
6. bicuspid aortic valve can produce an ejection click

Question 6

what investigations would be performed in suspected aortic stenosis

Answer 6

1 TTE (inc doppler)
-gold standard for diagnosis
-raised aortic pressure gradient, measurement of aortic valve area and LVEF
2 ECG
-signs of LVH, (deep S wave in V1-2, tall R wave in V5-6, inverted T waves in I, aVL, V5-6) LAD, LBBB
3 CXR
-post stenotic enlargement of ascending aorta
-calcification of aortic valve

Question 7

what are the levels of stenosis

Answer 7

supravalvar
valvar
subvalvar

Question 8

what % of patients with aortic stenosis have CAD

Answer 8

50%

Question 9

what precedes aortic stenosis

Answer 9

aortic sclerosis (aortic valve thickening without flow limitation)

Question 10

what are risk factors for aortic sclerosis

Answer 10

smoking
HTN
diabetes
hyperlipidaemia

Question 11

what is chronic kidney disease associated with

Answer 11

aortic valve calcification leading to aortic stenosis

Question 12

what is the most common presenting complaint in aortic stenosis

Answer 12

dyspnoea

Question 13

what is the link between aortic stenosis and von willdebrand deficiency

Answer 13

turbulent flow across the aortic stenotic valve may produced an acquired von willebrand deficiency

Question 14

what is balloon valvuloplasty

Answer 14

percutaneous procedure whereby a balloon is inflated at the level of the aortic valve to relieve the stenosis

Question 15

which valves commonly require anticoagulation

Answer 15

mechanical valves

Question 16

what is TAVR

Answer 16

transcatheter valve replacement

used in patients who are stable but the risks of surgery are high