Aortic Stenosis

Question 1

Simply put, what is aortic stenosis?

Answer 1

When the aortic valve doesn’t open all the way

It only opens 1cm2 when its meant to open 3-4cm2

Question 2

What are the causes of aortic stenosis

Answer 2

Stress over time - causing calcification and fibrosis - usually precipitates late adulthood

Bicuspid aortic valve instead of tricuspid (because stress per leaflet greater)

Chronic rheumatic fever - repeated damage and repair causes valves to fuse together (commissural fusion)

Question 3

What kind of murmur is present in aortic valve stenosis

Answer 3

Ejection systolic murmur (S1-S2) - may be diminished s2 sound

Crescendo decrescendo murmur

(gets louder then quieter)

A thrill may be palpable in aortic area if severe

Question 4

How does the LV change in aortic stenosis?

Answer 4

Concentric LV hypertrophy - sarcomeres added in parallel

Question 5

What are some consequences of aortic stenosis

Answer 5

Heart failure —> this could also present as syncope or angina

Also, microangiopathis haemolytic anaemia (damage to RBC as they passed through narrowed valve) - this may lead to haemoglobinuria

Question 6

What is treatment for aortic stenosis?

Answer 6

Valve replacement (often occurs after onset of symptoms)

Question 7

What features may be present on examination in someone with aortic stenosis

Answer 7

Narrow pulse pressure

Harsh ejection systolic murmur (crescendo-decrescendo)

Question 8

What are the first investigations to order?

Answer 8

ECG - evidence of LVH and absent Q waves helps distinguish aortic stenosis from other conditions e.g. IDH/aortic sclerosis

Transthoracic echocardiogram - estimates aortic valve area and pressure gradient across the valve, LV function, visualise structural changes involve

Question 9

Which 3 drugs should come to mind when looking to manage/prevent aortic stenosis?

Answer 9

Manage LV failure (so use ACEi/vasodilators cautiously) and antibiotic prevention against infective endocarditis