aortic stenosis

Question 1

define aortic stenosis

Answer 1

narrowing of the aortic valve so that the leaflets do not open normally and blood is unable to flow freely

Question 2

three most common valvular aortic stenosis

Answer 2

congenitally bicuspid aortic valve
senile degeneration and calcification
rheumatic fever

Question 3

congenitally bicuspid aortic valve

Answer 3

becomes calcified around the age of 30

Question 4

senile degeneration & calcification

Answer 4

becomes calcified after age 65

coronary arteries also calcified, no fusion of commissures

Question 5

rheumatic fever

Answer 5

commissures calcify in the 3rd and 4th decade

fused commissures

Question 6

most common location of aortic stenosis

Answer 6

valvular

Question 7

supravalvular stenosis

Answer 7

very rare- associated with William’s Syndrome, pulmonary stenosis, hypoplasia or aorta

Question 8

aortic valve stenosis symptoms and presentation

Answer 8

usually asymptomatic for many years
classic triad of symptoms
-angina (with exertion)
-exertion syncope
-congestive heart failure (usually left sided)
sudden death in severe stages after exercise
fatal in critical stages due to flordi pulmonary edema

Question 9

physical exam findings

Answer 9

• heaves and thrills with severe stenosis
• systolic ejection murmur all through systole
• split s2
• delayed carotid upstroke
• narrow pulse pressure

Question 10

systolic ejection murmur description

Answer 10

harsh
heard in right 2nd ICS
radiates to the left neck or armpit

Question 11

why split s2

Answer 11

slight delay in the av valve so s2 is slightly off between AV and PV so you can heart it

Question 12

what do you mean by narrow pulse pressure

Answer 12

less than 30 mmHg difference so 110/90

Question 13

Aortic stenosis on chest x ray

Answer 13

cardiomegaly with LV prominence, dilated ascending aorta with calcified AOV

Question 14

aortic stenosis in I aVL V4-6

Answer 14

increased R wave amplitude

Question 15

aortic stenosis III, aVR, V1-3

Answer 15

increased S wave depth

Question 16

aortic stenosis in leads V5 and V6

Answer 16

strain pattern with ST depression

Question 17

gold standard for aortic stenosis

Answer 17

echocardiogram

Question 18

echocardiogram findings

Answer 18

• thickened, calcified aortic valve
• bicuspid aortic valve (congenital)
• dilated aortic root
• concentric left ventricular hypertrophy
• hyperdynamic contraction
• left atrial enlargement
• increased aortic valve gradient (pressure across the valve)
• decreased aortic valve area (size of the opening)

Question 19

severity ratings

Answer 19

normal: 2.6-3.5 cm2
mild-moderate 1.3-1.7 cm2
severe: 1.0 cm2
critical less than .5 cm2

Question 20

when do people get sick with aortic stenosis

Answer 20

as soon as symptoms onset

Question 21

treatment for aortic stenosis

Answer 21

• balloon valvuloplasty

- aortic valve replacement

Question 22

risk for balloon valvuloplasty

Answer 22

risk breaking off calcified plaque

Question 23

bioprosthetic valve

Answer 23

bovine or procine ( 10 year expectancy) good for older patients with severe stenosis who do not have a long time to live
-no anticoagulation needed

Question 24

mechanical valve

Answer 24

for those with life expectancy greater than 10 years
requires life long anticoagulation on warfarin
needs lab monitoring and dose adjustment

Question 25

early changes of aortic stenosis

Answer 25

diastolic dysfuntion
Decreased in size of valve opening so decrease in aortic antegrade velocity (blood going out) causes decreases in your cardiac output so the left ventricle become hypertrophic to work harder to overcome that pressure this causes diastolic dysfunction because the ventricle cannot relax and fill up with blood during diastole- this causes increase atria size as blood backs up from mitral regurgitation

Question 26

late changes of aortic stenosis

Answer 26

systolic dysfunction

every muscle will fail even your heart muscle if you keep in pushing it

Question 27

coronary ostea

Answer 27

fill during diastole and sit right above the aortic valve- when not as much blood is going into the ascending aorta during relaxation then less blood flows to the heart- so you have a big fat heart with little 02 so you get ischemia