Aortic stenosis

Question 1

Aetiology:

Answer 1

• Senile calcification (most common cause, degenerative)
• Congenital (bicuspid valve, Willams syndrome)
• Rheumatic heart disease

Question 2

Symptoms:

Answer 2

• Angina
• Syncope
• Heart failure
• Long asymptomatic latent period
• Dyspnoea

Question 3

Signs:

Answer 3

• Prominent JVP if RH failure present
• Apex beat vigorous and sustained
• Slow rising pulse with narrow pulse pressure
• Quiet A2 (aortic valve closure)
• Ejection systolic murmur

Question 4

Investigations:

Answer 4

• ECG (shows LVH/ left ventricular strain)
• Echocardiogram (to assess LV function and hypertrophy)
• Cardiac catheterisation (to assess valve gradient)
• Cardiac MRI
• Chest x-ray (shows aortic valve calcification)

Question 5

Treatment:

Answer 5

Surgical replacement or repair of aortic valve