Aortic valve disease Flashcards
What is aortic stenosis
refers to narrowing of aortic valve orifice
aortic sclerosis is preclinical phase to aortic stenosis
What is the epidemiology of aortic stenosis
3rd most common CVD
prevalence increases with age
What are causes of aortic stenosis
degenerative calcification - due to age- common in older patients
bicuspid aortic valve - common in younger patients
williams syndrome
post rheumatic heart disease - mostly in developing world
subvalvular- hypertrophic obstructive cardiomyopathy
What may someone with aortic stenosis present with ?
classic triad of SAD symptoms on exertion-
Syncope
Angina
Dyspnoea
What findings may be found on examination in someone with aortic stenosis
EJECTION SYSTOLIC MURMUR
radiates to carotids
decreased following Valsalva maneuver
slow rising and delayed pulse
narrow pulse pressure
What investigations are required for aortic stenosis
- obtain an echocardiogram
- ECG
- consider cardiac MRI and cardiac catheterisation
What is management for AS if patient is asymptomatic
observe
Management for patient with AS if symptomatic
valve replacement
Management for patient with AS if asymptomatic but LVEF<50% and valvular gradient >40mmHg
consider surgery
What are the options of aortic valve replacement
surgical AVR treatment for young , low operative risk patients
Transcatheter AVR - for patients with high operative risk
balloon valvuloplasty
- children with no calcification/adults not fit for surgery
What does a patient who has had a mechanical valve also need
anticoagulation therapy
What is aortic regurgitation
leaking of aortic valve of heart which causes blood to flow in reverse direction during ventricular diastole
What can acute AR be caused by
infective endocarditis
aortic dissection/chest trauma
SURGICAL EMERGENCY
What can cause chronic AR
rheumatic heart disease
congenital anomalies- bicuspid aortic valve
connective tissue disorder- Marfans, Ehlers-danlos syndrome
RA
What may someone with AR present with
mild AR may be asymptomatic
- fatigue
-SOB
-chest pain
-fainting
-swelling of ankles and feet
-heart palpitations