Cardiac Valve Defects - Aortic Stenosis

Question 1

Aetiology of Aortic Stenosis (3).

Answer 1

1. Age-Related Calcification of a Normal Valve (Cumulative ‘Wear and. Tear’) = Aortic Sclerosis.
2. Cusp Calcification of a Bicuspid Valve (strongly associated with Aortic Coarctation).
3. Post-Rheumatic Fever Valve Disease.

Question 2

What is Aortic Sclerosis?

Answer 2

Thickening and calcification of aortic valve leaflets, without motion restriction i.e. the valve still opens and closes normally.

Question 3

Pathophysiology of Aortic Stenosis (5).

Answer 3

1. Progressive Impeding of Blood Flow during Systole.
2. Left Ventricle Outflow Obstruction.
3. LV Hypertrophy.
4. Reduced Compliance.
5. Elevation of Diastolic LV Pressure = LA Hypertrophy (Stiff Ventricle).

Question 4

Clinical Presentation of Aortic Stenosis (4).

Answer 4

1. Asymptomatic.
2. Angina.
3. Exertion Syncope.
4. Development of CCF (Congestive Cardiac Failure).

Question 5

Murmur in Aortic Stenosis (6).

Answer 5

1. Ejection Systolic Murmur.
2. High-Pitched (High Velocity of Systole).
3. Crescendo-Decrescendo (Speed of Blood Flow During Different Periods of Systole).
4. Radiating to Carotids.
5. Slow Rising Pulse.
6. Narrow Pulse Pressure.

Question 6

What effect does the Valsalva Manoeuvre have on Aortic Stenosis?

Answer 6

Murmur is decreased.

Question 7

Heart Sounds of Severe Aortic Stenosis (3).

Answer 7

1. Soft/Absent S2.
2. S4 Sound.
3. Thrill.

Question 8

ECG Findings in Aortic Stenosis (3).

Answer 8

1. Increased QRS Complex Amplitude.
2. Left Axis Deviation.
3. Poor R Wave Progression.

Question 9

CXR Finding in Aortic Stenosis.

Answer 9

Cardiomegaly.

Question 10

Management of Aortic Stenosis (3).

Answer 10

1. Asymptomatic - Conservative.
2. Symptomatic - Replacement.
3. Asymptomatic + Valvular Gradient > 40 = Surgery.

Question 11

Surgical Management of Aortic Stenosis (2).

Answer 11

1. Conventional Aortic Valve Replacement.
2. Transcatheter Aortic Valve Implantation (Severe).

Question 12

What is Transcatheter Aortic Valve Implantation (TAVI)? (5)

Answer 12

1. Insert a catheter into the femoral artery.
2. Feed wire under X-Ray guidance to aortic valve.
3. Inflate balloon to stretch the stenosed aortic valve.
4. Implant a bio prosthetic valve.
5. No Warfarin required.