aortic stenosis Flashcards
define aortic stenosis
narrowing of the aortic valve so that the leaflets do not open normally and blood is unable to flow freely
three most common valvular aortic stenosis
congenitally bicuspid aortic valve
senile degeneration and calcification
rheumatic fever
congenitally bicuspid aortic valve
becomes calcified around the age of 30
senile degeneration & calcification
becomes calcified after age 65
coronary arteries also calcified, no fusion of commissures
rheumatic fever
commissures calcify in the 3rd and 4th decade
fused commissures
most common location of aortic stenosis
valvular
supravalvular stenosis
very rare- associated with William’s Syndrome, pulmonary stenosis, hypoplasia or aorta
aortic valve stenosis symptoms and presentation
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
physical exam findings
- heaves and thrills with severe stenosis
- systolic ejection murmur all through systole
- split s2
- delayed carotid upstroke
- narrow pulse pressure
systolic ejection murmur description
harsh
heard in right 2nd ICS
radiates to the left neck or armpit
why split s2
slight delay in the av valve so s2 is slightly off between AV and PV so you can heart it
what do you mean by narrow pulse pressure
less than 30 mmHg difference so 110/90
Aortic stenosis on chest x ray
cardiomegaly with LV prominence, dilated ascending aorta with calcified AOV
aortic stenosis in I aVL V4-6
increased R wave amplitude
aortic stenosis III, aVR, V1-3
increased S wave depth
aortic stenosis in leads V5 and V6
strain pattern with ST depression
gold standard for aortic stenosis
echocardiogram
echocardiogram findings
- 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)
severity ratings
normal: 2.6-3.5 cm2
mild-moderate 1.3-1.7 cm2
severe: 1.0 cm2
critical less than .5 cm2
when do people get sick with aortic stenosis
as soon as symptoms onset
treatment for aortic stenosis
- balloon valvuloplasty
- aortic valve replacement
risk for balloon valvuloplasty
risk breaking off calcified plaque
bioprosthetic valve
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
mechanical valve
for those with life expectancy greater than 10 years
requires life long anticoagulation on warfarin
needs lab monitoring and dose adjustment
early changes of aortic stenosis
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
late changes of aortic stenosis
systolic dysfunction
every muscle will fail even your heart muscle if you keep in pushing it
coronary ostea
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
