Aortic Stenosis

Question 1

Define

Answer 1

Narrowing of the left ventricular outflow at the level of the aortic valve

Question 2

Causes

Answer 2

1. Stenosis secondary to rheumatic heart disease (commonest worldwide)
2. Calcification of a congenital bicuspid aortic valve
3. Calcification/degeneration of a tricuspid aortic valve in the
   elderly (senile calcification)

Question 3

Risk factors

Answer 3

congenital bicuspid valve

Question 4

Epidemiology

Answer 4

elderly, prevalence in 3% of 75 year olds Mortality rate ~50% at 2 years unless outflow obstruction relieved More common in MALES
Bicuspid artic valves may present earlier as young adults

Question 5

Symptoms

Answer 5

Angina (due to ↑O2 demand of hypertrophied ventricles)
􏰀 Syncope, dizziness on exercise
􏰀 Symptoms of HF - dyspnoea, orthopnoea

Question 6

Signs

Answer 6

􏰀 Narrow pulse pressure
􏰀 Slow rising pulse
􏰀 Thrill in aortic area (if server)
􏰀 Forceful sustained thrusting undisplaced apex beat
􏰀 Harsh ejection systolic murmur (ESM) at aortic area, radiates to carotid and apex
􏰀 Second heart sound may be softened or absent (due to calcification)
􏰀 Bicuspid valve may produce an ejection click

Question 7

Investigations

Answer 7

1. ECG
2. Chest xray
3. Angiography