aortic stenosis

Question 1

what is normal aortic valve size

Answer 1

3-4cm2

Question 2

when do symptoms of aortic stenosis

Answer 2

when valve area is ¼ of normal

Question 3

3 types of aortic stenosis

Answer 3

Supravalvular – above valve
Subvalvular – below valve
Valvular – most common

Question 4

pathology of aortic stenosis

Answer 4

1. narrow valve means obstructed LV emptying
2. pressure gradient develops between the LV and aorta
3. increased afterload 🡪 LV hypertrophy
4. results in:
   - increased myocardial oxygen demand
   - relative ischaemia of the myocardium and consequent angina - arrhythmias
   - LV failure
5. LV systolic function is typically preserved in aortic stenosis

Question 5

3 causes of aortic stenosis

Answer 5

1. Calcification of congenital bicuspid aortic valve (BAV) – most common and presents in middle age
2. Degeneration and calcification of a normal valve – presents in elderly
3. Rheumatic heart disease

Question 6

risk factors of aortic stenosis

Answer 6

Congenital BAV – predisposed to stenosis and regurgitation

Question 7

when should you always suspect aortic stenosis

Answer 7

in ANY elderly person with chest pain, exertional dyspnoea or syncope

Question 8

symptoms of aortic stenosis

Answer 8

1. Classic triad
   - Exertional syncope
   - Angina
   - Dyspnoea – due to HF
2. Heart failure

Question 9

signs of aortic stenosis

Answer 9

Slow rising (pulsus tardus) and weak (pulsus parvus) carotid pulse

Heart sounds
- Soft or absent 2nd heart sound – may become soft or inaudible when the valve becomes immobile
- Prominent 4th heart sound – due to LV hypertrophy
- Ejection systolic murmur – crescendo – decrescendo character

Question 10

4 investigations for aortic stenosis

Answer 10

1. Echocardiography (diagnostic)
2. chest X ray
3. ECG
4. Cardiac catheterisation

Question 11

what does chest x ray of aortic stenosis show

Answer 11

shows a normal heart size, LVH, prominence of the ascending aorta (post-stenotic dilatation) and there may be valvular calcification

Question 12

what does ECG of aortic stenosis show

Answer 12

Shows evidence of LVH and a LV stress pattern when disease is severe

ST depression and T-wave inversion in aVL, V5 and V6

Question 13

why is cardiac catheterisation done

Answer 13

used to exclude coronary artery disease

Question 14

surgical management of aortic stenosis

Answer 14

Aortic valve replacement – in symptomatic patients as onset of symptoms associated with 75% mortality at 3 years

If not medically fit for surgery, then Transcatheter Aortic Valve Implantation (TAVI) with a balloon expandable stent

Question 15

general management of aoritc stenosis

Answer 15

Dental hygiene/care – risk of infective endocarditis

IE prophylaxis in dental procedures