Symptoms and Signs

Question 1

What are the three cardinal symptoms of Aortic Stenosis and why do they occur?

Answer 1

SAD​

1. Syncope - mechanism unknown ?Aortic hypotension and less perfusion
2. Angina - Less supply to the myocytes due to increased systole time. This is because the ventricle is having to work harder so the cardiac vessels are compressed for longer. There is also more demand as the heart is working harder
3. Dyspnoea - LVH so increased atrial pressure is needed and therefore increase pulmonary vein pressure and oedema and dyspnoea

Question 2

Why are GI bleeds also a sign of Aortic Stenosis?

Answer 2

VwF gets damaged by the increase in sheer force across the valve

VwF - Used to bind platelets to endothelium and in FVIII

Question 3

What are the four main signs of Aortic Stenosis and why do they occur?

Answer 3

Left Ventricular Hypertrophy - Due to increased resistance of the valve

Slow Rising pulse - Due to slow movement through the valve

Reduced pulse pressure - Slow build up so less time to geto the arterioles

Ejection Systolic Murmur - Between first and second heart sounds

Question 4

What is unusual about aortic stenosis and it’s presentation?

Answer 4

It tends to present late when there is a marked drop in pressure across the valve

Question 5

What would you see on an ECG?

Answer 5

LVH

Big R on V4-6, Big S V1-3

Question 6

What other investigations other than an ECG may you do?

Answer 6

Coronary angiogram

Echo