Week Four - Case Three Flashcards
what is aortic stenosis
the narrowing of the three cusps that form the aortic valve
what are the congenital causes of aortic stenosis
Bicuspid Valve
Williams Syndrome
what is the most common cause of aortic stenosis
senile calcification
Look for corneal arcus
what are the signs of aortic stenosis
Ejection Systolic murmur best heard in the aortic area, ( Right 2nd intercostal space at border of sternum), radiating to the caroitds.
Slow-rising pulse, with a narrow pulse pressure (difference between systolic and diastolic pressures is small)
Heave – but apex beat is not displaced
Possible signs of:
- Heart failure / pulmonary hypertension: crackles at the lung bases, pink frothy sputum, oedema etc
- AF – irregularly irregular pulse
what are the symptoms of aortic stenosis
Angina
Syncope
Dyspnoea
Signs of any valve defect
Fatigue
Dyspnoea
what would an ECG show
L – LBBB – due do calcification
L – Left Axis Deviation
L – LVH
P – Poor R wave progression (i.e. depolarisation of the ventricles is slow)
what is used to estimate the pressure across the valve
a doppler echo
what are the pressure readings indicative of aortic stenosis
0 mmHg – normal valve
<30 mmHg – mild aortic stenosis
30-50 mmHg – moderate aortic stenosis
> 50 mmHg – severe aortic stenosis
what is cardiac catheritisation
this can assess the actual gradient across the valve as well as check for co-existing CADw
what is the prognosis of aortic stenosis if it goes untreated
This can be predicted with the presence of symptoms:
Angina present – 2 years
Syncope present – 1 year
Dyspnoea present – 6 months
what is the surgical management of aortic stenosis
Surgical –if symptomatic, then the prognosis is poor (above) and prompt valve replacement is recommended. Valve replacement is also recommended for patients with ECG signs, and moderate to severe disease on Doppler / cardiac catheterisation.
Patients should be placed on antibiotics to prevent bacterial endocarditis
how long to prosthetic valve replacements last
about 10 years, they may need a replacement
no need for long term anticoagulant therapy
what are the three types of a metal valve, how long do they last and what is the disadvantage
Metal –last a life time, but require anticoagulant therapy for life. Also noisy (often make a loud ‘click’ sound).
There are three types of metal valve:
- Tilting disc
- Double tilting disc
- Ball in a cage
what is the most common indication for cardiac valve surgery
symptomatic aortic stenosis is the most common idication
how may a patient with severe aortic stenosis present
Symptomatic fluid overload (SOB/orthopnoea/peripheral oedema)
Exertional syncope
Chest pain