Aortic Stenosis by Blonder SRS

Question 1

What is the most common cause of LV outflow obstruction?

Answer 1

Aortic stenosis… duh!

Question 2

What is the most common congenital anomoly of the heart?

Answer 2

Bicuspid AV

Question 3

Is Bicuspid AV more common in men or women?

Answer 3

Men 4:1

Question 4

What is the indication for a valve replacement?

Answer 4

Any one of the three cardinal symptoms

1. DOE (dyspnea on exertion)
2. Syncope (near syncope, exertional lightheadedness)
3. Angina of effort

**Any one of these symptoms are indications for valve replacement as life expectancy is reduced to < 3 years**

This card is a likely TQ

Question 5

What are the three cardinal symptoms of AS?

Answer 5

1. DOE (dyspnea on exertion)
2. Syncope (near syncope, exertional lightheadedness)
3. Angina of effort

Question 6

What is the course of untreated AS? (5 ste

Answer 6

1. The obstruction to outflow from the LV causes LVH first,
2. then LA dilatation,
3. finally LV dilatation
4. CHF
5. death

Question 7

What is the phonogram shape of an ejection murmur?

Answer 7

Crescendo-Decrescendo

(not a TQ, but I think this may come up in our SP)

Question 8

How is aortic stenosis diagnosed?

Answer 8

1. Done correctly, PE can be diagnostic
   
   • Crescendo-decrescendo murmur
   • Murmur radiates to clavicle and carotid
2. Echocardiography is indicated if significant AS is suspected
3. Symptoms, especially in the elderly

Question 9

How do you know if a patients aortic stenosis is severe?

Answer 9

Left ventricular hypertrophy must be present for it to be severe

Question 10

What might you spot on inspection in a patient with aortic stenosis?

Answer 10

1. Patient may appear SOB with labored breathing
2. JVD (late finding due to right heart failure)

Question 11

What might you find on palpation of a patient with aortic stenosis?

Answer 11

1. Displaced PMI d/t LVH
2. precordial thrill at 3rd interspace, LSB may be felt
3. Severe AS radiates a “shudder” into the carotid, like a cat purring in the neck. You can diagnose AS by careful palpation of the carotids, before you listen to the heart.

Question 12

What is a shudder?

Answer 12

palpable radiated murmur

Question 13

What are the ausculatative findings in AS?

Answer 13

1. •S1 normal, SEM (systolic ejection murmur) at base, radiates into neck and onto the clavicles (much easier to hear)
2. Almost always radiates onto the clavicle