Aortic Stenosis

Question 1

Define Aortic Stenosis

Answer 1

Obstruction of blood flow across the aortic valve due to narrowing

Question 2

Aetiology Aortic Stenosis

Answer 2

Senile calcification (80%)
Bicuspid valve
William’s syndrome
Rheumatic heart disease

Question 3

Epidemiology Aortic Stenosis

Answer 3

Most common valvular disease and 2nd most frequent cause for cardiac surgery
Those with bicuspid aortic valves typically present 2 decades earlier than trileaflet
Largely a disease of older people

Question 4

Presenting symptoms Aortic Stenosis

Answer 4

Chest pain 
Exertional dyspnoea, reduced exercise tolerance
Syncope
Dizziness
Epistaxis or bruising

Long subclinical period of reduced exercise capacity, angina, syncope and HF

Typically syncope following a period of increasing SOB on exertion + angina

Question 5

Signs Aortic Stenosis

Answer 5

Ejection systolic murmur heard best over right sternum 2nd ICS - will RADIATE to the carotid arteries
Slow rising pulse
Narrow pulse pressure
Parvus et tardus - diminished and delayed carotid upstroke
Heaving, non-displaced apex beat
Palpable thrill
Severe stenosis - split S2

Question 6

Investigations Aortic Stenosis

Answer 6

Echo - Aortic valve narrowing

ECG - LVH with strain pattern, Left axis dev, LBBB
CXR - Calcified valve, post-stenotic dilation of ascending aorta
Cardiac catheter - assess valve gradient and LV function
FBC - rule out MI
Trop - rule out MI