Aortic Stenosis

Question 1

Pathophysiology of AS

Answer 1

Male>female

Obstruct LV outflow > pressure overload on LV > CONCENTRIC LV HYPERTROPHY

Question 2

Causes of AS

Answer 2

-common :
Rheumatic
Calcific
Bicuspid valve

-uncommon ;
Radiation
Drugs

-rare:
Ochronosis 
Hypercholestrimia in children 
Paget diseases 
Other congenital uni/quadro cuspid

Question 3

DDx of AS

Answer 3

1- hypertrophic cardiomyopathy :marked hypertrophy of LV particularly INTERVENTRICULAR SEPTUM

2-Discrete congenital sub-valvular AS

3- supra-valvular AS :
.uncommon

Question 4

AS symptoms

Answer 4

The Classic Triad :

1-Angina

2-Syncope

3-dyspnea , orthopnea ,PND

Question 5

Px general finishes of PS:

Answer 5

Pulse:usually regular,AF(Kate in coarse)

Slow rising pulse or pulsus parvus er tardus

Carotid shudder (thrill transmitted to CA)

BP: narrow pulse pressure

JVP; prominent a wave

Question 6

Px pericardium:

Answer 6

-inspection:

Apical Impulse visible

-palpation:
Sustained apical impulse
Laterally displaced apex
Systolic thrill

-auscultation:
S1 : soft/ normal 
S2:is Single or paradoxically split 
S4
Ejection click 
MID-systolic murmur Crescendo decrescndo diamond shaped harsh murmur

Question 7

Investigation:

Answer 7

ECG :
LVH &LV strain (st depression and t wave inversion leads I avL V5-6 )

CXR: little or no cardiac enlargement for years
Post stenotic dialation if aorta
Aortic valve calcification
Cardiomegaly pulmonary congestion