Aortic Stenosis

Question 1

What is aortic stenosis?

Answer 1

Narrowing of aortic valve at the outflow of the left ventricle
Caused by calcification of the valve

Question 2

What are the three main symptoms for valve disease?

Answer 2

Chest pain
Lightheaded
Short of breath

Question 3

What are the two possible causes of aortic stenosis?

Answer 3

Calcification of valve over time

Congenital - valve may be bicuspid rather than tricuspid

Question 4

Why does aortic stenosis cause left ventricle hypertrophy? What is this an example of?

Answer 4

LV has to work harder to generate more pressure to eject blood through the narrowed aortic valve

Pressure overload

Question 5

What group is aortic stenosis most common for?

Answer 5

Males >65

Question 6

Does aortic stenosis cause symptoms always?

Answer 6

Can be asymptomatic for many years

Question 7

Symptoms

Answer 7

Angina type chest pain - made worse by exercise and improved by rest
Breathlessness with exercise
Light headedness with exercise

Question 8

Signs

Answer 8

Harsh and loud “ejection systolic” heart murmur, loudest in right side of chest (aortic area)
Reduced pulse pressure (reduced difference between systolic and diastolic pressure -e.g. around 20mmHg rather than 50)
Forceful apex beat (mid-clavicular, 5th intercostal space)

Question 9

Where is the apex beat felt?

Answer 9

Left side
Mid-clavicular
5th intercostal space

Question 10

Why can aortic stenosis cause light-headedness during exercise?

Answer 10

Less O2 to brain

May cause syncope (faint)

Question 11

What will be different about blood pressure?

Answer 11

During ventricular ejection, left ventricular pressure will be greater than aortic pressure

Difference between systolic and diastolic pressure will be reduced (reduced pulse pressure)

Question 12

Abnormal test results

Answer 12

ECG (electrocardiogram) shows evidence of more muscular left ventricle - bigger QRS complex

Echocardiogram (ultrasound scan of heart) shows a narrowed aortic valve and hypertrophied left ventricle

Question 13

What is a coronary angiogram?

Answer 13

Catheter passed up to heart and contrast medium injected to look at coronary arteries

Question 14

What is the classic sign for a small valve on an angiogram?

Answer 14

Prussian helmet (little pointy bit on top of helmet at start of aorta)

Question 15

Treatment options

Answer 15

Surgery - aortic valve replacement - open chest surgery or percutaneous through skin and femoral artery (TAVI = Transcatheter aortic valve implantation)

Then lifelong anticoagulants (warfarin if prosthetic valve)

Question 16

What types of valve can be used for replacement?

Answer 16

Prosthetic - metal

Tissue - usually pig

Question 17

Which patients would be more likely to get a prosthetic valve replacement?

Answer 17

Young people - last longer

Question 18

What are the benefits of tissue valve replacements?

Answer 18

No need for lifelong warfarin (anticoagulant)

Question 19

What surgery could be done on an elderly patient who wouldn’t survive open heart surgery?

Answer 19

Stent to open the valve

Question 20

What is an aortic valvuloplasty?

Answer 20

widening of a stenotic aortic valve using a balloon catheter inside the valve