Aortic Stenosis

Question 1

Define Aortic Stenosis?

Answer 1

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

Question 2

What is the aetiology of Aortic Stenosis?

Answer 2

Stenosis can be secondary to rheumatic heart disease (most common worldwide)
Calcification of a congenital bicuspid aortic valve
Calcification/degeneration of a tricuspid aortic valve in the elderly

Question 3

What is the epidemiology of aortic stenosis?

Answer 3

Present in 3% of 75 years old
More common in males
Those with bicuspid aortic valve present earlier

Question 4

What are the presenting symptoms of Aortic Stenosis?

Answer 4

May be asymptomatic initially
Angina (due to increased oxygen demand of the hypertrophied left ventricle)
Syncope or dizziness on exercise (due to outflow obstruction)
Symptoms of heart failure (e.g. dyspnoea, orthopnoea)

Question 5

What are the signs of Aortic Stenosis on examination?

Answer 5

Narrow pulse pressure
Slow-rising pulse
Thrill in the aortic area (only if severe)
Forceful sustained thrusting undisplaced apex beat
Ejection systolic murmur at the aortic area, radiating to the carotid artery
Second heart sound may be softened or absent (due to calcification)
A bicuspid valve may produce an ejection click

Question 6

What investigations would you do for Aortic Stenosis?

Answer 6

ECG
CXR
Echocardiogram
Angiogram

Question 7

What would you see on an ECG for Aortic Stenosis?

Answer 7

Signs of	left	ventricular	hypertrophy:
• Deep S in V1/2
• Tall R in	V5/6
• Inverted T waves	in I,	aVL	and	V5/6
• Left axis deviation

LBBB

Question 8

What would you see on a CXR for Aortic Stenosis?

Answer 8

Post-stenotic enlargement of ascending aorta

Calcification of aortic valve

Question 9

Why do we do an Echocardiogram for Aortic Stenosis?

Answer 9

Visualises structural changes of the valves and level of stenosis (valvar, supravalvar or subvalvar)
Estimation of aortic valve area and pressure gradient across the valve in systole
Assess left ventricular function

Question 10

Why do we do a Cardiac Angiography in Aortic Stenosis?

Answer 10

Allows differentiation from other causes of Angina (e.g. MI)

Allows assessment of concomitant coronary artery disease

Question 11

What is important to remember with some patients with Aortic Stenosis?

Answer 11

50% of patients with severe Aortic Stenosis have significant CAD