Aortic stenosis

Question 1

Aortic stenosis?

Answer 1

Narrowing of the left ventricular outflow at the level of the aortic valve.

Question 2

Aortic stenosis risk factors (3)?

Answer 2

secondary to rheumatic heart disease (most common worldwide),

calcification of a congenital bicuspid aortic valve,

calcification/degeneration of a tricuspid aortic valve in the elderly.

Question 3

Aortic stenosis epidemiology?

Answer 3

3% of 75yrs, males, those with aortic bicuspid valve present earlier.

Question 4

Aortic stenosis symptoms?

Answer 4

Initially asymptomatic then angina,

syncope or dizziness on exercise,

symptoms of heart failure (e.g. dyspnoea, orthopnoea)

Question 5

Aortic stenosis signs?

Answer 5

Narrow pulse pressure,

slow rising pulse,

thrill in aortic area (if severe),

forceful sustained thrusting undisplaced apex beat,

ejection systolic murmur at aortic area,

radiating to the carotid artery,

second heart sound softened or absent.

Question 6

Aortic stenosis investigations?

Answer 6

ECG (signs of left ventricular hypertrophy i.e. deep S in V1/2, tall R in V5/6, inverted T waves in 1, aVL, and V5/6 left axis deviation, LBB)

CXR (post-stenotic enlargement of ascending aortic valve)

Echocardiogram (visualise structural changes in valves and level of stenosis, assess left ventricular function)

Cardiac angiography (allows differentiation from other causes of angina).

Question 7

Aortic stenosis ECG?

Answer 7