Aortic stenosis Flashcards
Define aortic stenosis
Narrowing of the left ventricular outflow at the level of the aortic valve
Explain the aetiology and risk factors of aortic stenosis
Stenosis can be secondary to rheumatic heart disease (MOST COMMON WORLDWIDE)
Calcification of a congenital bicuspid aortic valve
Calcification/degeneration of a tricuspid aortic valve in the elderly
Summarise the epidemiology of aortic stenosis
Present in 3% of 75 yr olds
More common in males
Those with bicuspid aortic valve present earlier
Recognise the presenting symptoms of aortic stenosis
May be ASYMPTOMATIC initially
Angina (due to increased oxygen demand of the hypertrophied left ventricle)
Syncope or dizziness on exercise (due to outflow obstruction)
Symptoms of heart failure (e.g. dyspnoea, orthopnoea)
Recognise the signs of aortic stenosis on examination
Narrow pulse pressure
Slow-rising pulse
Thrill in the aortic area (only if severe)
Forceful sustained thrusting undisplaced apex beat
Ejection systolic murmur at the aortic area, radiating to the carotid artery
Second heart sound may be softened or absent (due to calcification)
A bicuspid valve may produce an ejection click
Identify appropriate investigations for aortic stenosis
ECG
Signs of left ventricular hypertrophy - Deep S in V1/2, Tall R in V5/6, Inverted T waves in I, aVL and V5/6, Left axis deviation
LBBB
CXR
Post-stenotic enlargement of ascending aorta
Calcification of aortic valve
Echocardiogram
Visualises structural changes of the valves and level of stenosis (valvar, supravalvar or subvalvar)
Estimation of aortic valve area and pressure gradient across the valve in systole
Assess left ventricular function
Cardiac angiography - Allows differentiation from other causes of angina (e.g. MI)
Allows assessment of concomitant coronary artery disease
NOTE: 50% of patients with severe aortic stenosis have significant coronary
artery disease
