Aortic stenosis Flashcards
What is aortic stenosis?
narrowing of LV outflow at the level of the aortic valve
List 5 causes of AS
Calcification/degeneration (most common >65)
Bicuspid valve (most common in <65)
Williams syndrome: supravalvular AS
Post-rheumatic heart disease
Subvalvular: HOCM
What are 3 presenting symptoms of AS?
Angina (increased O2 demand of hypertrophied LV)
Dyspnoea
Syncope/ pre syncope (e.g. Exertional dizziness)
Describe the murmur in AS
Ejection systolic in aortic area
Radiates to carotids
Decreases following the valsalva manoeuvre
Describe 7 signs of severe AS on examination
Narrow pulse pressure
Slow-rising pulse
Delayed ESM
Soft/ absent S2
S4
Thrill in aortic area
Heaving undisplaced apex beat
What may be seen on ECG in AS?
Signs of LV hypertrophy
Signs of LV strain
What may be seen on CXR in AS?
Cardiac enlargement
Post-stenotic enlargement of ascending aorta
Calcification of aortic valve
Why perform an echocardiogram in AS?
Confirms presence of AS Assesses degree of valve calcification, Assesses LV function + wall thickness Detects presence of other associated valve disease or aortic pathology Provides prognostic info.
Why perform cardioangiography in AS?
Allows differentiation from other causes of angina (e.g. MI)
Allows assessment of concomitant coronary artery disease
Mx of asymptomatic patients with AS
Observation
Regular cardiology OP review
Mx of symptomatic AS
Aortic valve replacement
When are asymptomatic patients with AS considered for surgery?
Valvular gradient >40mmHg
Evidence of LV systolic dysfunction
What are the options for aortic valve replacement? Which groups are more suitable for each?
Surgical AVR: young, low/med op risk
Transcatheter AVR: high op risk
Why is angiogram performed prior to surgical AVR?
Cardiovascular disease may co-exist
Can combine AVR + CABG
In which patients with AS may balloon valvuloplasty be used?
Children with no aortic calcification
Adults with critical stenosis no fit for valve replacement
