AORTIC STENOSIS

Question 1

DDx: Etiology

Answer 1

Degenrative Calcification
RHD
Bicuspid Aortic Valves

Question 2

Risk Factors: Degenerative Calcification

Answer 2

Increasing Age
HTN
Smoking
Elevated Cholesterol
Diabetes

Question 3

Symptoms

Answer 3

Classic Triad: dyspnea, chest pain, syncope
Classic symtoms usually take a stepwise progression fo dyspnea -> chest pain -> syncope

End Stage: Congestive heart Failure

Question 4

Physical Exam

Answer 4

Harsh late peaking systolic ejection murmur at the Right second intercostal space

Radiating to carotids

Paradoxical splitting of S2

+/- S3, S4

Pulse with low amplitude, slow rise, sustained peak

Brachioradial delay with simultaneous palpation of the rt brachial and radial pulses

Narrowed Pulse Pressure

Question 5

Complications

Answer 5

Heart Failure
Afib - this is REALLY BAD

Question 6

Workup

Answer 6

ECG
CXR
Echocardiography

Question 7

ECG Findings

Answer 7

Left Ventricular Hypertrophy

Question 8

Drugs to Avoid

Answer 8

Negative inotropics: BB, CCB

Question 9

Drugs to Use with Caution

Answer 9

Nitrates
Vasodilators
Diuretics

Question 10

Management of Afib

Answer 10

Cardiovert!!!

Question 11

Mortality rate of angina, syncope, CHF

Answer 11

Angina: 50% in 5 years
Syncope: 50% in 3 years
CHF: 50% in 2 years