Aortic Stenosis

Question 1

what is the management of aortic stenosis?

Answer 1

transcatheter aortic valve implantation (TAVI) or sugical aortic valve replacement (SAVR).

TAVI = comorbidities, previous heart surgery, frality, restricted mobility, >75 years old

SAVR = low risk, <75 years old

Question 2

what is the classic triad of symptoms for aortic stenosis?

Answer 2

• heart failure
• syncope
• angina

Question 3

what are the examination findings in aortic stenosis?

Answer 3

• slow rising carotid pulse
• narrow pulse pressure
• heaving, non-displaced apex beat
• ejection systolic murmur
• soft S2 heart sound
• ejection click may be heard in some cases (early systolic)

Question 4

what is the characteristics of the murmur heard in aortic stenosis?

Answer 4

ejection systolic murmur
* heard best at the second intercostal space on the right
* can be described as ‘harsh’
* transmitted well to the carotids

Question 5

what anticoagulant should a patient be on post metallic aortic valve replacement?

Answer 5

warfarin

metallic valves should be anticoagulated with a vitamin K antagonist

Question 6

what are the ECG findings in aortic stenosis?

Answer 6

evidence of left ventricular hypertrophy
* increased QRS complex voltage
* left axis deviation
* poor R-wave progression

Question 7

what parameters on an echo would indicate severe aortic stenosis?

Answer 7

• peak gradient >40mmHg
• valve area <1.0 cm x2
• aortic jet velocity >4 m/s

Question 8

what are the classic findings of aortic sclerosis?

Answer 8

• ejection systolic murmur that does not radiate to the carotids
• normal S2
• normal pulse character and volume

Question 9

what is aortic sclerosis?

Answer 9

asymptomatic condition that can be incidentally revealed through physical examination or via echo

Question 10

what is the cause of aortic sclerosis?

Answer 10

age-related senile degeneration of the valve

Question 11

what are the indications for intervention in aortic stenosis?

Answer 11

symptomatic disease
asymptomatic + LVEF <50%
asymptomatic with LVEF >50% + symptoms when exercising
asymptomatic with LVEF >50% + risk factors:

risk factors:
aortic valve peak velocity >5.5 m/s x2
severe calcification and peak velocity progression >0.3 m/s x2
markedly elevated BNP levels
severe pulmonary hypertension (>60mmHg)