Aortic Stenosis

Question 1

Aortic Stenosis Epidemiology

Answer 1

• Most prevalent form of valvular disease

- Degenerative cause in western world, rheumatic cause in developing countries

Question 2

Aortic Stenosis RFs

Answer 2

-Congenital bicuspid vale predisposes to stenosis and regurgitation

Question 3

Aortic Stenosis Presentation

Answer 3

• Presence or absence of symptoms is key demarcation point
• Shortness of breath on exertion, angina, dizziness, syncope
• Often asymptomatic
• Murmur can be faint so may present as heart failure of unknown cause
• Can cause syncope and even death on exertion
• Can predispose to angina
• Narrow pulse pressure

Question 4

Aortic Stenosis vs Regurgitation Structural Changes

Answer 4

• In stenosis, left ventricle hypertrophies as more force required
• In regurgitation, heart has to pump required output plus regurgitated output, so ventricle dilates

Question 5

Aortic Stenosis Differentials

Answer 5

• Aortic sclerosis (thickening without stenosis, can lead to aortic stenosis, all cases of stenosis come from sclerosis)
• Endocarditis
• HOCM

Question 6

Aortic Stenosis Ix

Answer 6

• Echo is key diagnostic tool
• ECG, CXR
• Exercise testing for risk stratification

Question 7

Aortic Stenosis Management

Answer 7

• Surgery is definitive therapy, strongly recommended for symptomatic patients
• Avoid heavy exertion, stress test can determine recommended level of exercise
• Treat co-existing hypertension carefully to avoid hypotension
• Stenosis is strong risk factor for coronary artery disease; modify RFs