Aortic Stenosis

Question 1

Indicators severity of AS

Answer 1

• Early ejection click
• Long Systolic murmur
• Late peaking of the murmur
• 4th heart sound
• Paradoxical splitting of S2
• Heaving apex beat which is displaced
• Systolic thrill
• Pulsus parvus et tardus
• Narrow pulse pressure

Area < 1cm, velocity > 4, peak gradient > 40

Question 2

What is Gallavardin phenomenon?

Answer 2

• Systolic murmur may radiate towards the apex, which may be confused with a MR murmur

Question 3

Differential diagnoses for an ejection systolic murmur?

Answer 3

• AS
• PS
• HOCM
• MVP/MR
• Coarctation

How do you differentiate between them?
• AS and PS – expiration and inspiration
• AS and HOCM – Valsalva, squatting
• AS and MVP – location and clicks
• AS and Coarctation – differential pulse

Question 4

Median survival post onset symptoms AS

Answer 4

Angina 5 years
Syncope 3 years
Dyspnea 2 years

Question 5

Causes for AS

Answer 5

• Rheumatic heart disease (<60)
• Degenerative calcification (>75)
• Calcified biscupid (60-75, males)

Question 6

Indications surgery AS

Answer 6

• Severe AS and symptomatic (angina, syncope, SOB)
• Severe AS with reduced EF (< 50%) even if asymptomatic (controversial)
• Expanding aortic root (> 4.5 cm, or >0.5 cm/year)

Question 7

Define normal and abnormal pulse pressures

Answer 7

What is pulse pressure?
• Difference between systolic and diastolic pressure
• Normal – 40mmHg
• Wide - >60 mmHg
• Narrow - <25mmHg
• Note: There is no official definition but studies usually measures the pulse pressure as a continuum