Aortic stenosis

Question 1

How to define it?

Answer 1

Narrowing of the aortic valve which prevents blood flowing into the aorta.

Question 2

Causes

Answer 2

Chronic rheumatic disease
-Inflammation 
-Causes fibrosis
-Leaflets fuse together 
Mechanical stress over time:
-Leads to calcification 
-Hardens valve
Bicuspid valve
-Increased stress on both valves

Question 3

How to develop

Answer 3

Valve does not open easily
There is a build up of pressure in the LV
Click when it opens
Turbulent flow through narrow space- murmur

Question 4

Investigations

Answer 4

ECG- ST/T changes
CXR- calcification of the AV
Cardiac cauterisation

Question 5

signs

Answer 5

Examination:

• JVP: prominent in RH failure
• BP: low
• Apex beat: vigorous
• RV heave
• Murmur: crescendo-decrescendo:

Increase in pressure In ventricle leads to left concentric hypertrophy

Haemoglobinuria

Question 6

Symptoms

Answer 6

Asymptomatic for long phase 
Chest pain
Syncope
SOB on exertion
Heart failure

Question 7

What is microangiopathic haemolytic anaemia

Answer 7

• Splitting of RBCs as they pass through valve

- Can lead to hemoglobinuria- haemoglobin in the urine

Question 8

What are the risks during increased exercise

Answer 8

Risk of heart failure during exercise:

• Less blood pumped
• To brain leads to syncope
• In heart can lead to chest pain, angina

Question 9

Explain the crescendo-decrescendo murmur

Answer 9

Increases as blood flows through

Decreases as less blood available in ventricle

Question 10

Where can it radiate to?

Answer 10

The neck:

-Associated with the aorta and the first branches of the aorta are the carotids

Question 11

Why do you get a RV heave

Answer 11

Hypertrophy of the right ventricle due to back flow into pulmonary circulation