Aortic stenosis

Question 1

Tell me about valve cusps

Answer 1

All valves are tricuspid

Mitra valve is the only bicuspid valve

Question 2

what causes aortic stenosis

Answer 2

Depends on age
children - congenital AS, subvalvular stenosis, supravalvular stenosis.

middle age/young - calcification and fibrosis of bicuspid congenital valve or rhuematic aortic stenosis

Middle to elderly: senile degenerative aortic stenosis, calcification of bicuspid valve, rheumatic aortic stenosis

Question 3

Presentation of AS

Answer 3

AS can be asymptomatic for many years. But when symptoms start patients deteriorate rapidly.
The three cardinal symptoms of AS are angina, Syncope and breathlessness

Question 4

How does AS cause angina

Answer 4

So in AS LV is hypertrophied because of increased pressure gradient against pump.
Thus after hypertrophy there will be more demand for oxygen but less blood supply becuase recently hypertrophied. therefore angina starts despite the existence of coronary artery disease.
sometimes angina is present because of coronary artery disease especially in 50+

Question 5

Why does syncope occur

Answer 5

It occurs usually on exertion because the heart is unable meet the demand of blood leading to fall in BP

Question 6

What are the signs of aortic stenosis

Answer 6

Ejection systolic murmur
slow rising carotid pulse
narrow pulse pressure
Thrusting apex beat 
pulmonary oedema

Question 7

Tell me about AS murmur

Answer 7

Harsh ejection systolic murmur that radiates to the neck

Question 8

How to investigate AS

Answer 8

ECG - maybe strain pattern many are normal

Echo

Question 9

How to manage AS

Answer 9

Asymptomatic AS has good prognosis therefore requires conservative management and continuous reviews especially doppler echos

If they are symptomatic they need prompt surgical intervention