Aortic stenosis Flashcards
Define aortic stenosis
Narrowing of the left ventricular outflow at the level of the aortic valve
Aetiology of aortic stenosis
3
Can be secondary to rheumatic heart disease (MOST COMMON WORLDWIDE)
Calcification of congenital bicuspid aortic valve
Calcification/degeneration of tricuspid aortic valve in the elderly
Epidemiology of aortic stenosis
age, gender, bicuspid presentation
3% of 75 year olds
More common in males
Those w/ bicuspid aortic valve present earlier
Presenting symptoms of aortic stenosis
4
May be initially ASYMPTOMATIC
Angina (due to inc. O2 demand of hypertrophied L ventricle)
Syncope or dizziness on exercise (due to outflow obstruction)
Symptoms of heart failure (e.g dyspnoea, orthopnoea)
Signs of aortic stenosis on examination
7
- Narrow pulse pressure
- Slow rising pulse
- Thrill in the aortic area (only if severe)
- Forceful sustained thrusting undisplayed apex beat
- Ejection systolic murmur at aortic area, radiating to carotid artery
- 2nd heart sound may be softened or absent (due to calcification)
- Bicuspid valve may produce an ejection click
Investigations for aortic stenosis
4 groups
ECG
CXR
ECHOCARDIOGRAM
CARDIAC ANGIOGRAPHY
Investigations for aortic stenosis - ECG
2
Signs of L ventricular hypertrophy
- Deep S in V1/2
- Tall R in V5/6
- Inverted T waves in I, aVL & V5/6
- Left axis deviation
LBBB
Investigations for aortic stenosis - CXR
2
- Post stenotic enlargement of ascending aorta
- Calcification of aortic valve
Investigations for aortic stenosis - echocardiogram
3
- Visualises structural changes of valves & level of stenosis (valvar, supravalvar, subvalvar)
- Estimation of aortic valve area & pressure gradient across valve in systole
- Assess L ventricular function
Investigations for aortic stenosis - cardiac angiography
2
- Allows differentiation from other causes of angina (e.g. MI)
- Allows assessment of concomitant coronary artery disease (50% have)
