Aortic valve stenosis Flashcards
Describe how rheumatic heart disease can causes aortic stenosis
Adhesion, fusion of the commissures
Retraction and stiffening of the free cusp margins
Describe how a degenerative valve can cause aortic stenosis
Atheroma - inflammatory process leading to thickening and calcification of the cusps from base to free margins
What re the symptoms of aortic stenosis?
Long asymptomatic phase Chest pain (angina) Syncope SOB on exertion HF
What are the signs on clinical examination?
Small volume pulse, slow rising Prominent JVP in R HF Heaving apex beat Systolic murmur radiating to the carotids S4
What investigations should be carried out?
ECG CXR Angiography Echo Cardiac MRI
What are the treatment options?
Limited to those who developed HF
Aortic valve replacement or repair
Pathophysiology
LV emptying impaired because of high outflow resistance Resistance increases LV systolic pressure
This increases afterload, a decrease in stroke volume, and an increase in end-systolic volume
What is the effect of increased LV systolic pressure?
LV hypertrophy Increase LV EDP -> PHT Increased myocardial O2 demand Myocardial ischaemia LV failure
What are 3 causes of aortic stenosis?
Degenerative valve
Rheumatic heart disease
Bicuspid - inherited heart disease where two leaflets fuse
How does aortic stenosis cause pulmonary hypertension?
Increase LV EDP causes the LA pressure to increase and causes back flow to the pulmonary vasculature -> PHT
How does aortic stenosis cause increase myocardial O2 demand and myocardial ischaemia?
LV myocardium has increased demand due to hypertrophy
Less flow out of aortic valve, therefore less blood getting to coronary arteries
What will an CXR show with AS?
Calcification of AV
What will an ECHO show with AS?
AV cusp mobility
LV function and hypertrophy
Doppler haemodynamic assessment of pressure gradient
