aortic stenosis Flashcards
when should cardiac catheterisation be done
when there is a concern about concomitant mitral valve disease
before surgery
treatment for childhood
vagotomy
other causes of valvular stenosis
- chronic kidney disease
- Paget’s disease of bone
- previous radiation exposure
- systemic lupus erythematosus
what is murmur like
ejection systolic
crescendo-decresencdo
what is most common cause
calcific aortic valvular disease (CAVD)
what is most common form of congenital heart disease
bicuspid aortic valve
what is CAVD
inflammatory process involving macrophages and T lymphocytes
treatment for symptomatic patients
aortic valve replacement
what does it include
- calcific stenosis of a trileaflet aortic valve
- stenosis of congenitally bicuspid valve
- rheumatic aortic stenosis
what may be felt in the aortic area
systolic thrill
signs
- sinus rhythm
- systolic thrill
- apex is non-displaced
- ejection click
- ejection systolic murmur
symptoms
- chest pain
- breathlessness
- syncope
- pre-syncope
- fatigue
who gets bicuspid aortic valve disease
new born babies
what are other causes of obstruction to left ventricular emptying
- supravalvular obstruction
- subvalvular aortic stenosis
- hypertrophic cardiomyopathy
what is supravalvular obstruction
congenital fibrous diaphragm above the aortic valve
are extra heart sounds heard
yes S4
where does murmur radiate to
carotids
what is subvalvualr aortic stenosis
congenital condition in which the fibrous ridge or diaphragm is situated immediately below the aortic valve
what calcifies in CAVD
lipoproteins
where is murmur best heard
aortic area
what is the pulse like
slow-rising
what is seen on echo
- thickened, calcified aortic valve cusps
- left ventricular hypertrophy
used to determine severity
what is done if patient is unfit for surgery
balloon dilatation but results are poor
what does calcification reduce
systolic opening
treatment for patients with BAV and enlarged ascending aorta
surgical intervention
what is prognosis once symptoms occur
poor
2-3 years
what is seen on CXR
- small heart
- dilated aorta
- aortic valve calcified
what can rheumatic fever produce
progressive fusion, thickening and calcification of the aortic valve
risk factors for CAVD
- old age
- men
- elevated lipoprotein and LDL
- hypertension
- diabetets
- smoking
what is supravalvular obstruction associated with (2)
- mental retardation
- hypercalcaemia
what is bicuspid aortic valve associated with
- aortic coarctation
- root dilatation
- aortic dissection
treatment for asymptomatic patients
regular review for assessment
and
echo
what is done for diagnosis
- CXR
- ECG
- echo
- cardiac catheterisation
what is a novel treatment for patients unsuitable for surgical replacement
transcatheter implantation with a balloon expandable stent valve
who usually gets CAVD
elderly
what else is associated with rheumatic fever
mitral valve disease
what does it produce
obstruction to the left ventricular stroke volume
what does obstructed left ventricular emptying lead to
increased left ventricular pressure and compensatory left ventricular hypertrophy
what does left ventricular hypertrophy lead to
ischaemia of the left ventricular myocardium
- angina
- arrhythmias
- left ventricular failure
what is seen on ECG
- left ventricular hypertrophy
- left atrial delay
- arrhythmias may be present
