Aortic Valve Disease

Question 1

Aortic valve disease

Answer 1

Includes :
1. aortic stenosis
2. aortic regurgitation
3. combined disease

Question 2

Aortic stenosis

Answer 2

• Most common valve disorder in developed countries
• Obstruction of flow across aortic valve due to fibrosis and calcification

Question 3

Main causes of aortic stenosis

Answer 3

1. degenerative calcification (> 65years)
2. rheumatic fever (causes mixed disease)
3. congenital abnormalities (bicuspid valve)

Question 4

Pathophysiology of aortic stenosis

Answer 4

1. valve leaflet calcification (or fibrosis)
2. valve leaflet restriction
3. left ventricular hypertrophy (from pressure overload)
4. ischaemia and heart failure develop

Question 5

Clinical features of aortic stenosis

Answer 5

• exertional dyspnoea
• exertional angina
• exertional syncope
• HF symptoms

Question 6

Murmur caused by aortic stenosis

Answer 6

• mid-late systolic ejection murmur
• can ** radiate to carotids**
• increased stenosis, softer murmur
• crescendo-decresendo

Question 7

Cardiac exam findings in aortic stenosis

Answer 7

• systolic ejection murmur
• slow-rising pulse
• low volume carotid pulse
• narrow pulse pressure
• heaving apex beat
• soft or absent S2
• reverse splitting of S2

Question 8

Managing aortic stenosis

Answer 8

Definitive treatment:
- surgical aortic valve replacement (SAVR)
- transcatheter aortic valve replacement (TAVI)

Palliative measures:
- balloon valvotomy

Question 9

Complications of aortic stenosis

Answer 9

• HF
• sudden cardiac death
• arrhythmias (esp. AF)
• GI bleeding
• endocarditis

Question 10

Aortic regurgitation

Answer 10

• aortic valve leaflets do not close properly
• allows blood to leak back into ventricle

Question 11

Main causes of aortic regurgitation

Answer 11

Valvular disease:
- rheumatic fever
- infective endocarditis
- connective tissue disease
- bicuspid valve

Aortic root disease/dilation:
- aortic dissection
- spondylarthropathies
- hypertension
- syphillis
- marfans, ehler-danlos

Question 12

Symptoms of aortic regurgitation

Answer 12

• dyspnoea
• fatigue
• palpitations

Question 13

Cardiac exam findings in aortic regurgitation

Answer 13

• collapsing pulse
• wide pulse pressure
• quinkes sign
• de mussets sign
• murmur

Question 14

Aortic regurgitation murmur

Answer 14

Decresendo early-diastolic blowing murmur

Question 15

Quinkes sign

Answer 15

• pulsing nailbed
• seen in aortic regurgitation

Question 16

De mussets sign

Answer 16

• head bobbing with pulse rate
• seen in aortic regurgitation

Question 17

Managing aortic regurgitation

Answer 17

• medically manage signs/symptoms of HF
• aortic valve surgery