Valves - Aortic Stenosis

Question 1

Aetiology?

Answer 1

Degenerative/Calcification - linked to atheroma

Rheumatic heart disease

Congenital

Question 2

Effects of aortic stenosis

Answer 2

Increased LV systolic pressure
LV failure
Causes severe LVH
Increases LV EDV, causing LA pressure to increases. causing pulmonary hypertension
Increases myocardial O2 consumption and myocardial ischaemia - as blood can’t get out so heart works harder but then needs more O2

Question 3

Symptoms? When do these symptoms start showing?

Answer 3

Long asymptomatic phase - starts showing when stenosis is severe and aortic orifice is a third of its normal size

Exercise induced syncope
Angina
Dyspnoea

Question 4

Examination results?

Answer 4

Low volume and slow rising pulse
Prominent JVP
RV heave
Aortic thrill
Vigorous apex beat
Ejection systolic murmur

Question 5

Investigations?

Answer 5

ECG
Echo
CxR

Question 6

What does the ECG look for?

Answer 6

LVH

ST/T changes for LV strain

Question 7

What does echo’s look for?

Answer 7

AV cusp mobility
LV function
LVH

Question 8

What is the CxR looking for?

Answer 8

Calcification of AV

Question 9

Who is treatment reserved for?

Answer 9

Those in heart failure

Question 10

What is the surgical treatment?

Answer 10

Aortic valve replacement or repair

Question 11

What does the doppler type echo look for?

Answer 11

Haemodynamic assessment of pressure gradient and AV area