Aortic stenosis

Question 1

Define:

Answer 1

Narrowing of the left ventricular outflow at the level of the aortic valve

Question 2

Aetiology/risk factors:

Answer 2

> 60 yrs (senile calcification)

Rheumatic heart disease (most common cause and inflammation will lead to calcification)

Chronic kidney disease (dialysis leads to calcification)

Bicuspid aortic valve

Question 3

Epidemiology:

Answer 3

3% of 75 year olds have AS

greater in males than females

if have bicuspid aortic valve will present earlier

Question 4

Symptoms:

Answer 4

elderly will present with chest pain, exertional dyspnoea and syncope

angina

syncope or dizziness

HF symptoms (orthopnea and dyspnoea)

Faints

systemic emboli in infective endocarditis

sudden death

Question 5

Signs:

Answer 5

EJECTION SYSTOLIC MURMUR @ aortic area that radiates to the carotids

narrow pulse pressure

slow rising pulse

thrill in the aortic region

heaving undisplaced apex beat

second heart sound softened or absent (calcification as less closure)

ejection click if have bicuspid aortic valve

Question 6

Investigations:

Answer 6

echo is diagnostic and will visualise structural changes in the valve + level of stenosis

Cardiac angiography - differentiate between other causes of angina

CXR - calcification of the valve, LVH and post stenotic enlargement of the aortic valve

ECG

Question 7

What would an ECG show for AS:

Answer 7

P mitriale (left atrial enlargement)

Signs of LVH:

• Deep S in V1/2
• Tall R in V5/6
• inverted t wave in I, avl, V5/6

LBBB or complete AV block

left axis deviation