Aortic Valve Disease Flashcards
What is Aortic Stenosis
- obstruction of blood flow across the aortic valve due to valve fibrosis and calcification
- progressive disease
Presentation of aortic stenosis
-fatigue, exertional symptoms; SOB, angina, syncope, HF
Diagnosis
- systolic murmur radiates to carotids- loudest at right upper sternal border
- S2 diminished
- (uncommon) Gallavardin’s phenomenon
- bleeding - from acquired von Willebrand deficiency
Murmurs graded 1-6:
1) faint
3) loud
4) palpable thrill
6) heard w/o stethoscope
INVESTIGATIONS
1) TTE (including Doppler)- carotid parvus et tardus
- ECG
- chest x-ray
ECG
- left ventricular hypertrophy due to pressure overload-
- absent Q waves
- AV block, hemiblock, BBB
CONSIDER:
- cardiac MRI cMRI
- cardiac catheterisation
- ECG exercise stress testing
- dobutamine stress echo
Case history for aortic stenosis
1) A 78-year-old man presents to his primary care physician complaining of 2 months of progressive shortness of breath on exertion. He first recognises having to catch his breath while gardening and is now unable to walk up the stairs in his house without stopping. Previously he was healthy and active without similar complaints. On physical examination there is a loud systolic murmur at the right upper sternal border radiating to the carotid vessels
Risk factors for aortic stenosis
- > 60 years
- congenitally bicuspid aortic valve
- rheumatic heart disease
- CKD
WEAK
- radiotherapy
- high LDL
- hyperlipoproteinaemia
- hypertension
- elevated lipoprotein
Other differentials to aortic stenosis
- aortic sclerosis
- ischaemic heart disease IHD
- hypertrophic cardiomyopathy HCM
Classification of aortic stenosis
Stage A: at risk of AS
- valve anatomy: bicuspid aortic valve, congenital
- max aortic velocity <2m/s
- no symptoms
Stage B: Progressive AS
-velocity 2-2.9 m/s
Stage C: Asymptomatic severe AS
-max velocity >4m/s
Stage D123: Symptomatic severe AS
