Cardiology

Question 1

Causes of aortic stenosis?

Answer 1

> 65 age : Degenerative calcification
<65 age : bicuspid aortic valve

William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM

Question 2

What is valvular gradient?

Answer 2

The pressure gradient across a defective valve, expressed as an increase and decrease on either side of the valve

Normally it is a few mmHg

Question 3

What is the most common valve disease and the most common cause of valve replacement surgery?

Answer 3

Aortic stenosis

Question 4

Features of symptomatic aortic stenosis?

Answer 4

chest pain
dyspnoea
syncope / presyncope (e.g. exertional dizziness)
ejection systolic murmur (ESM) - classically radiates to the carotids
this is decreased following the Valsalva manoeuvre

Question 5

Features of severe aortic stenosis?

Answer 5

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

Question 6

Outline management of aortic stenosis:

Answer 6

Asymptomatic = observe the patient
Symptomatic = valve replacement
Asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction = consider surgery

Question 7

What types of AVR are there?

Answer 7

options for aortic valve replacement (AVR) include:
surgical AVR is the treatment of choice for young, low/medium operative risk patients.
Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined

Transcatheter AVR (TAVR) is used for patients with a high operative risk

Balloon valvuloplasty- may be used in children with no aortic valve calcification
In adults limited to patients with critical aortic stenosis who are not fit for valve replacement

Question 8

When should coronary angioplasty/ PCI be performed in NSTEMI?

Answer 8

If GRACE score >3%
Within 72 hours of admission