Aortic stenosis

Question 1

Cardinal features of aortic stenosis

Answer 1

slow rising pulse, narrow pulse pressure and ejection systolic murmur radiating to the neck.

Question 2

Differentiate between ejection systolic murmur and pan systolic murmur

Answer 2

Ejection systolic murmur radiating to back = aortic stenosis
Pansystolic murmur which does not radiate to back = mitral regurg

Question 3

Investigations

Answer 3

ECG
FBC
Trops 
CXR
Coronary angiogram 
Echo

Question 4

Describe CXR appearance in severe cases of aortic stenosis

Answer 4

Actually looks normal because the left ventricle hypertrophies rather than dilates

Question 5

What changes are seen in the heart with severe aortic stenosis?

Answer 5

LVHypertrophy

Question 6

What is the imaging modality of choice?

Answer 6

Echo

Question 7

Most common cause of aortic stenosis in someone under 60/young patients?

Answer 7

Bicuspid aortic valve

Question 8

Treatment of choice

Answer 8

Valve replacement

Question 9

Most common cause of aortic stenosis in someone over60/older patients?

Answer 9

Degenerative valve disease

Question 10

If the patient is not fit to undergo open heart surgery, what are some other options?

Answer 10

Valvuloplasty (catheter insertion to open up the valve) or transcatheter aortic valve implantation (TAVI

Question 11

How might you diagnose LVH on an ECG?

Answer 11

S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm