Aortic stenosis

Question 1

Define what aortic stenosis is?

Answer 1

Obstruction of the aortic valve due to calcification or thickening

Question 2

Which gender is it most common in?

Answer 2

Men (elderly too)

Question 3

What is the aetiology?

Answer 3

Degenerative:
-calcification and inflammation

Cogenital:
-Bicuspid

Rheumatic heart disease:
-autoimmune due to strep group A

Question 4

How many cm should aortic valve be around?

Answer 4

1.5-2cm

Question 5

Describe the pathological process behind rheumatic disease?

Answer 5

It causes fusion of the commissures and stiffening + adhesion

Question 6

Describe the pathological process behind degenerative disease

Answer 6

Its linke dto athlerosclerosis

The inflammation process can lead to thickening and calcification of the cusps

Question 7

Describe the general pathological process that leads to symptoms

Answer 7

Increase in LV systolic pressure
Causes hypertrophy of the LV
Therefore increase in LV End diastolic pressure

Increase in pulm pressure

Causes myocardial ischaemia

LV failure

Question 8

What are the symptoms?

Answer 8

SAD!

S- syncope
A- angina:
D- dyspnoea

Question 9

What are the signs?

Answer 9

Carotid pulse = slow rising and low volume
JVP raised = if have right heart failure
Apex beat = sustained and vigurous
Right ventricle heave

Question 10

What is the ausculation heard?

Answer 10

High pitch systolic murmur

Brrr Dub

Radiates to the carotid arteries = systolic murmur

Can sometimes hear S4 if the atria is contracting against stiff hypertrophic ventricles

Question 11

What are the investigations?

Answer 11

ECG:

• LV hypertrophy
• ST/T changes
• AV gradient > 50mmHg

CXR:
-calcification of AV

ECHO:

• demonstrate mobility of AV cusp
• LV function/hypertrophy
• AV gradient

Cardiac catheterisation
CMR

Question 12

What is the treatment?

Answer 12

Aortic valve replacement or repair
-balloon valvuloplasty is limited to patients with critical stenosis who are not fit for AV replace

If asymptomatic:
observe