Aortic Stenosis

Question 1

Which anatomical structures are affected in aortic stenosis

Answer 1

Aortic valve

At the outflow of left ventricle

At the origin of the ascending aorta

Question 2

Physiology of aortic stenosis

Answer 2

Aortic valve opens to allow blood flow to EXIT left ventricle,

Then closes to prevent back flow (regurgitation)

Question 3

What structural abnormalities are present in aortic stenosis

Answer 3

Congenital - aortic vaulted may be bicuspid instead of tricuspid - more likely

The aortic valve becomes calcified, then narrowed (stenosed) over many years

Question 4

What physological abnormalities are present in aortic stenosis

Answer 4

• LV has to generate more force to force all blood out of stenosed valve
• so LV becomes muscular - hypertrophied

= “pressure overload”

Question 5

What is the typical patient with aortic stenosis

Answer 5

• males over age of 65
• may experience no symptoms for years

Question 6

Symptoms of aortic stenosis

Answer 6

• Angina chest pain (increase upon exertion)
• breathless with exercise
• light headedness to collapse with exercise

Question 7

Clinical signs of aortic stenosis

Answer 7

• LOUD HARSH ejection systolic heart murmur (top right)
• reduced PULSE pressure - - the difference between S + D blood pressure (usually 40 - now 20)
• forceful apex beat felt on midclavicular line, in 5th intercostal space

Question 8

Abnormal test results associated with aortic stenosis

Answer 8

ECG shows more muscular LV ——QRS increased in size

Echo cardio gram = narrowed aortic valve, hypertrophied LV

Question 9

Medical intervention:

Answer 9

• if pressure between ventricle and aorta below 60 mmHg = kept in for observation
• if LV starts dilation = surgery

Question 10

What surgical interventions are there for aortic stenosis:

Answer 10

• aortic vaulted replacement via open chest surgery
• percutaneous (via femoral artery) valve replacement

Question 11

What are the primary and secondary preventions of aortic stenosis

Answer 11

• IF metallic valve replacement - life long anticoagulant treatment with WARFARIN

(Patients with tissue vaulted don’t require warfarin)