Aortic valve disease Flashcards
What are the pathophysiology of aortic stenosis?
Most cases are due to calcification and fibrosis of the aortic valve
Congenital biscuspid valve is the most common cause of aortic stenosis in younger patients
Rheumatic heart disease
What are the symptoms associated with aortic stenosis?
Exertional dyspnoea
Chest pain
Exertional syncope
Fatigue
What murmur may be heard in aortic stenosis?
Ejection-systolic high pitched murmur over aortic area
Radiates to carotids
Enhanced on expiration
Thrill over aortic area
What are the other features of aortic stenosis?
Narrow pulse pressure
Slow rising pulse
Soft/absent S2
S4
Left ventricular hypertrophy
What are the primary causes of aortic regurgitation?
Chronic rheumatic fever
Infective carditis
SLE associated endocarditis
Bicuspid aortic valve
What are the secondary causes of aortic regurgitation?
Idiopathic aortic root dilatation
Aortic root aneurysms
Aortic root dilatation from connective tissue disorders
Aortic dissection
Syphilitic aortitis
What are the symptoms of aortic regurgitation?
Exertional dyspnoea
Fatigue
Palpitations
Orthopnoea
Paroxsymal nocturnal dyspnoea
What murmur will be heard in aortic regurgitation?
Early diastolic murmur/rumbling murmur heard at the apex
Heard loudest during end expiration
Heard loudest with patient leaning forwards
What features of aortic regurgitation may be seen on examination?
Wide pulse pressure
Collapsing pulse
What investigations are useful in the diagnosis of aortic valve disease?
ECG - evaluate for left ventricular hypertrophy
TTE - used to confirm diagnosis
CXR
BNP
What are the indications for valve replacement in aortic stenosis?
Severe aortic stenosis and symptomatic
Severe aortic stenosis, asymptomatic, and one of:
- Evidence of heart failure
- Symptoms on exercise testing
What is the management of mild to moderate aortic regurgitation?
Lifestyle modifications
ACE-inhibitors - ramipril
Beta blockers - bisoprolol
What is the management of severe aortic valve disease?
Loop diuretics - manage HF associated with aortic regurgitation
Aortic valve repair or replacement
What are the complications of aortic regurgitation?
Left ventricular dysfunction
Heart failure
AF
Sudden cardiac death
