Aortic stenosis

Question 1

AS causes

Answer 1

Senile calcification (60yrs +): commonest
Congenital: Bicuspid valve (40-60yrs), William’s syndrome
Rheumatic fever

Question 2

Symptoms of AS

Answer 2

Triad: angina, dyspnoea, syncope (esp.  ̄c exercise)
LVF: PND, orthopnoea, frothy sputum
Arrhythmias
Systemic emboli if endocarditis
Sudden death

Question 3

Signs of AS

Answer 3

Slow rising pulse

Ejection systolic murmur - radiates to carotids

Question 4

Severe AS signs

Answer 4

Quiet / absent A2
S4
Narrow pulse pressure
Decompensation: LVF

Question 5

Differentials of AS

Answer 5

Coronary artery disease
Mitral Regurgitation
Aortic sclerosis
Hypertrophic obstructive cardiomyopathy

Question 6

Investigations in AS

Answer 6

Bloods: FBC, U+E, lipids, glucose
ECG: LVH
CXR: Calcified AV (esp. on lateral films), LVH
Echo + Doppler: diagnostic
Cardiac Catheterisation + Angiography
Exercise Stress Test: Contraindicated if symptomatic AS

Question 7

Medical treatment of AS

Answer 7

Optimise Risk: statins, anti-hypertensives, DM
Monitor with echo
Angina: β-Blocker
Heart failure: ACEi and diuretics
Avoid nitrates

Question 8

Surgery for AS

Answer 8

Replacement
Balloon valvuplasty: high complication rate
Transcatheter Aortic Valve Implantation

Question 9

Different types of valves for replacement

Answer 9

Mechanical valves: last longer but require anticoagulation - young patients
Bioprosthetic valves: fail 10-15yrs

Question 10

TAVI

Answer 10

Transcatheter Aortic Valve Implantation