Aortic Stenosis ☺️

Question 1

Epidemiology

Etiology

Answer 1

Narrowing of aortic valve restricting flow from LV => A
May also affect LA pressure

65+ - degenerative calcification
U65 - bicuspid aortic valve
Supravalvular stenosis - William syndrome
Subvalvular stenosis - HOCM
Post rheumatic fever (AI reaction post GAS)

Question 2

Presentation of aortic stenosis

-findings on examination

Answer 2

Syncope, angina, dyspnoea
Ejection systolic murmur => carotid radiation, decreased with Valsalva
Slow rising, narrow pulse pressure
-soft S2 (reduced force of closure)
-S4 (atria contract against hypertrophied LV)
-reverse splitting (P2A2)
LVH

Question 3

Investigations

Answer 3

CXR - assess for cardiomegaly
ECG - assess for LVH
Echo - visualise valve movements
Angiogram - rule out coronary issues

Question 4

Management

• unstable
• asymptomatic
• symptomatic

Answer 4

Unstable - balloon valvuloplasty in cath lab
Stable and asymptomatic
-observe unless valvular gradient 40mmHg+ AND LV systolic dysfunction => valve replacement surgery
Stable and symptomatic
- valve replacement