Aortic valve disease

Question 1

Aortic stenosis causes

Answer 1

Senile calcification (most common)
Congenital
Rheumatic heart disease

Question 2

Aortic stenosis presentation

Answer 2

Elderly person with chest pain, exertional dyspnoea

Classic triad of: angina, syncope, heart failure

Question 3

Aortic stenosis signs

Answer 3

Slow rising pulse
Diminished delayed carotid upstroke
Aortic thrill
Ejection systolic murmur

Normal S1
A2 quiet or delayed in severe stenosis

Question 4

Aortic stenosis ECG

Answer 4

LVH and LBBB
p-mitrale
LAD
Poor R wave progression
Complete AV block with calcified ring

Question 5

Aortic stenosis CXR

Answer 5

LVH
Calcified aortic valve
Post-stenotic dilatation of ascending aorta

Question 6

Aortic stenosis tests

Answer 6

ECG
CXR
Echo is diagnostic
Doppler echo

Question 7

Aortic stenosis Doppler echo findings

Answer 7

Severe stenosis if gradient across valve ≥40 and valve area <1cm^2
If aortic jet velocity >4m/s, risk of complications increased

Question 8

Aortic stenosis management

Answer 8

Surgery if moderate-severe, even if asymptomatic

TAVI if pt not medically fit for surgery

Question 9

What is aortic sclerosis

Answer 9

Senile degeneration of valve

Ejection systolic murmur but no carotid radiation or pulse abnormality

Question 10

Aortic regurgitation acute causes

Answer 10

Infective endocarditis
Ascending aortic dissection
Chest trauma

Question 11

Aortic regurgitation chronic causes

Answer 11

Congenital
Connective tissue disorders
Rheum conditions (SLE, RA, Takayasu's, seronegatives)
Rheumatic fever
HT

Question 12

Aortic regurgitation symptoms

Answer 12

Exertional dyspnoea
Orthopnoea

Palpitations
Angina
Syncope

Question 13

Aortic regurgitation signs

Answer 13

Water-hammer pulse

Corrigan's sign
de Musset's sign
Quincke's sign
Duroziez's sign
Traube's sign
Austin-Flint murmur in severe

Question 14

What is Corrigan’s sign

Answer 14

Carotid pulsation

Question 15

What is de Musset’s sign

Answer 15

Head nodding with each heart beat

Question 16

What is Quincke’s sign

Answer 16

Capillary pulsations in nail beds

Question 17

What is Duroziez’s sign

Answer 17

Finger compressing femoral artery in groin 2cm proximal to stethoscope gives systolic murmur as blood flows backwards

Question 18

What is Traube’s sign

Answer 18

Pistol shot sound over femoral arteries

Question 19

Aortic regurgitation tests

Answer 19

ECG shows LVH
CXR shows cardiomegaly, dilated ascending aorta, pulmonary oedema
Echo is diagnostic

Question 20

Aortic regurgitation management

Answer 20

Reduce systolic HT
Echo every 6-12mths to monitor

Surgery if:
Severe AR with enlarged ascending aorta
Increasing symptoms
Enlarging/deteriorating LV function
IE refractory to medical therapy

Question 21

Aortic regurgitation poor post-op survival indicators

Answer 21

Ejection fraction <50%
NYHA Class III/IV
CCF>12mths