Aortic Stenosis

Question 1

Which anatomical structures are affected in aortic stenosis?

Answer 1

aortic valve at the outflow to left ventricle and origin of ascending aorta

Question 2

What is the physiology of the aortic valve?

Answer 2

It opens to allow blood to exit the left ventricle

It closes to prevent blood from passing backwards from the aorta to left ventricle regurgitation

Question 3

What is a common congenital malformation of the aortic valve?

Answer 3

It may have 2 cusps (bicuspid) rather than the usual 3 cusps (tricuspid)

Question 4

What happens to the aortic valve during aortic stenosis?

Answer 4

It becomes calcified and narrowed (stenosed) over many years

Question 5

How does aortic stenosis affect the left ventricle?

Answer 5

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

It becomes hypertrophied (more muscular)

Question 6

What type of people does aortic stenosis most commonly affect?

Answer 6

Men over the age of 65 years

Question 7

What are the early symptoms of aortic stenosis?

Answer 7

It can be asymptomatic for many years

Question 8

What are the 3 symptoms experienced by patients?

Answer 8

1. angina type chest pain which is worse with exercise but improved by rest
2. breathlessness
3. light-headedness with exercise

Question 9

What clinical sign can be heard?

Where is it heard?

Answer 9

Harsh and loud “ejection systolic” heart murmur

Heard loudest in the aortic area (top right side of the chest)

Question 10

What is pulse pressure?

What is normal pulse pressure?

Answer 10

Difference between systolic and diastolic blood pressure

Normally 120/70 mmHg = 50 mmHg

Question 11

How is pulse pressure changed in aortic stenosis?

Answer 11

reduced

BP is 110/90 mmHg so pulse pressure is 20 mmHg

Question 12

How does the apex beat change in aortic stenosis?

Answer 12

Forceful apex beat

This is felt on the left side, mid-clavicular line, 5th intercostal space

Question 13

What does the ECG of someone with aortic stenosis look like?

Answer 13

QRS complex increased in size due to LV hypertrophy

Question 14

What does the echocardiogram of someone with aortic stenosis look like?

Answer 14

You can see the narrowed aortic valve and a more muscular (hypertrophied) left ventricle

Question 15

What are the criteria to keep a patient under observation but not operate?

Answer 15

If the pressure difference between the left ventricle and aorta remains below 60 mmHg

Question 16

When is surgery considered irrespective of echocardiogram scan results?

Answer 16

If the left ventricle starts to dilate or symptoms are present

Question 17

What surgical procedure is used to treat aortic stenosis?

Answer 17

Open chest surgery to replace the aortic valve

or

a percutaneous approach through the skin and via femoral artery

Question 18

What are the 2 different types of surgical valves?

Answer 18

Prosthetic valves - made of metal or plastic

Tissue valves - pig valves

Question 19

What treatment do patients with artificial (prosthetic) valves require?

Answer 19

Life-long anticoagulant treatment with Warfarin

Question 20

What treatment do patients with tissue valves require?

Answer 20

They do not require warfarin