Aortic stenosis

Question 1

What is Aortic Stenosis (AS)?

Answer 1

Narrowing of aortic valve resulting in obstruction to forward flow of blood into the aorta

Question 2

What is the prevalence of Aortic Stenosis in the general population?

Answer 2

2nd most common valvular disease after mitral regurgitation

Question 3

What is the most common valvular disorder in the elderly?

Answer 3

Aortic Stenosis

Question 4

What is the 5-year mortality in mild and severe Aortic Stenosis?

Answer 4

• 40% in mild Aortic Stenosis
• 50% in severe Aortic Stenosis

Question 5

What is the prevalence of Aortic Stenosis in adults over 85 years of age?

Answer 5

Affects 5% of adults

Question 6

What are the causes of Aortic Stenosis in infants and children?

Answer 6

• Congenital Aortic Stenosis
• Congenital subvalvular and supravalvular Aortic Stenosis

Question 7

What is the most common cause of Aortic Stenosis in adults under 70 years of age?

Answer 7

Calcification of bicuspid aortic valve

Question 8

What is the most common cause of Aortic Stenosis in adults over 70 years of age?

Answer 8

Senile degenerative Aortic Stenosis

Question 9

What are the clinical features of mild to moderate Aortic Stenosis?

Answer 9

Usually asymptomatic

Question 10

What symptom is associated with reduced cardiac output in Aortic Stenosis?

Answer 10

Angina

Question 11

What causes syncope in patients with Aortic Stenosis?

Answer 11

Reduced cardiac output, atrial fibrillation, decline in BP

Question 12

What heart failure symptoms are associated with Aortic Stenosis?

Answer 12

• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea

Question 13

What is an anacrotic pulse in Aortic Stenosis?

Answer 13

Weak (parvus) and delayed (tardus) carotid pulsation

Question 14

What are the common signs of Aortic Stenosis?

Answer 14

• Low systolic BP with narrow pulse pressure
• Heaving apex beat due to left ventricular hypertrophy

Question 15

What is the characteristic murmur in Aortic Stenosis?

Answer 15

Ejection systolic murmur: Harsh, loud, long, diamond shaped, crescendo-decrescendo murmur

Question 16

What findings might be seen on an ECG in Aortic Stenosis?

Answer 16

Left ventricular hypertrophy with left atrial enlargement

Question 17

What is the gold standard test for diagnosing Aortic Stenosis?

Answer 17

ECHO

Question 18

What criteria indicate severe Aortic Stenosis?

Answer 18

• Aortic valve area (AVA) <1.0 cm²
• Mean transaortic pressure gradient >40 mm Hg
• Peak aortic jet velocity >4 m/sec

Question 19

What is the medical management for Aortic Stenosis?

Answer 19

• Alpha-Blockers
• Sublingual nitroglycerine
• Diuretics
• Reduction of cardiovascular risk factors
• Periodic ECHO

Question 20

What are the surgical treatments for severe Aortic Stenosis?

Answer 20

• Aortic valve replacement
• Aortic balloon valvuloplasty

Question 21

True or False: Transthoracic ECHO is the gold standard for the diagnosis of Aortic Stenosis.

Answer 21

True

Question 22

What is the most likely cause of a loud crescendo-decrescendo systolic murmur in a 25-year-old man?

Answer 22

Bicuspid calcific aortic stenosis

Question 23

What is the most probable cause of mid-systolic ejection murmur in a 75-year-old lady with syncope?

Answer 23

Senile calcific aortic stenosis