Blonder - Aortic Stenosis

Question 1

What is the most common cause of LV outflow obstruction in adults?

Answer 1

Aortic stenosis

Question 2

What is the most common congenital anomaly of the heart?

Answer 2

Bicuspid aortic valve

Question 3

What is the progression of cardac remodeling from aortic stenosis?

Answer 3

Initially, obstruction of LV outflow causes LVH

LVH progresses to L atrial dilation

L atrial dilation is followed by L ventricular dilation

L ventricular dilation leads to CHF and then death

Question 4

What are the three cardinal symptoms of aortic stenosis?

Answer 4

Dyspnea on exertion (usually a component of heart failure)

Syncope

Angina of effort

Question 5

In pts with aortic stenosis, what does the development of one of the cardinal sx indicate?

Answer 5

Development of cardinal sx indicate the need for valve replacement

Question 6

What is the characteristic shape of an ejection murmur?

Answer 6

Crescendo-decrescendo

Question 7

What are some physical exam findings associated with aortic stenosis?

Answer 7

JVD if there is R heart failure

LVH presenting as large apical impulse

Possible precordial thrill, 3rd ICS at LSB

Normal S1, systolic ejection murmur at base that radiates into neck (can also be heard on clavicles)

Question 8

What is a differential for a murmur that stops at the base of the heart and does not radiate into the neck?

Answer 8

Hypertrophic obstructive cardiomyopathy

Question 9

What is a “shudder” on palpation?

Answer 9

Sign of aortic stenosis if the aortic murmur can be felt over the carotids

Feels like the purring of a cat