Aortic Stenosis

Question 1

Clinical signs of aortic stenosis

Answer 1

Slow rising pulse, low pulse volume
Narrow pulse pressure
Apex beat undisplaced (Sustained in Stenosis)
Thrill in 2nd ICS right sternal edge
Murmur

Question 2

Murmur of aortic stenosis

Answer 2

Crescendo decrescendo ESM

Heard loudest in aortic area, best during expiration and radiating to carotids

Question 3

aortic stenosis complications + signs

Answer 3

Bacterial endocarditis: Osler nodes, Janeway lesions, Roth spots, splenomegaly, fever, haematuria, splinter haemorrhages
Left ventricular dysfunction: displaced apex beat, SOB, bibasal crackles

Question 4

Differential Dx for aortic stenosis

Answer 4

Aortic sclerosis (normal pulse character and no radiation)
Aortic flow
VSD
HOCM

Question 5

Causes of aortic stenosis

Answer 5

Congenital (bicuspid)
Age (degenerative changes and calcification)
Streptococcal infection (rheumatic valve)

Question 6

Prognosis of AS based on sxs

Answer 6

Angina - 50% 5y mortality
Syncope - 50% 3y mortality
Breathlessness - 50% 2y mortality

Question 7

Echo criteria for AS severity

Answer 7

Aortic valve area:
<1cm^2 - severe
<0.8cm^2 - critical

Question 8

Mx of asymptomatic AS

Answer 8

No specific mx.
Good dental health
Regular review of sxs and echos.

Question 9

Mx of symptomatic AS

Answer 9

Surgical: aortic valve replacement +/- CABG
Percutaneous: balloon aortic valvuloplasty, transcatheter aortic valve implantation

Question 10

Dukes criteria

Answer 10

Major criteria:
Typical (HACEK) organisms in two blood cultures
Echo: abscess, dehiscence, vegetations
Minor criteria:
Pyrexia >38
Echo suggestive 
Predisposition e.g. Prosthetic valve
Embolic phenomena
Vasculitic phenomena (high CRP or ESR)
Atypical organisms on blood cultures

2 major, 1 maj and 2 minor, or 5 minor criteria.

Question 11

When do you use prophylactic Abx to prevent BE?

Answer 11

Prosthetic valves
Previous endocarditis
Cardiac transplants with valvulopathy
Some types of congenital heart disease