Aortic Stenosis Flashcards
Define aortic stenosis
Narrowing of the aortic valve opening that restricts blood flow from the left ventricle to the aorta
What is the normal area of the aortic valve?
3-4 square centimetres
When do symptoms occur?
When area gets to 1/4 of normal
When should you think of AS in an elderly patient?
When they present with chest pain, exertional dyspnoea, syncope
What are the common causes of AS?
Senile calcification, congenital bicuspid valve, rheumatic heart disease
Describe the pathophysiology of AS
A pressure gradient forms between LV and aorta. Initially, LV function is maintained by compensatory pressure hypertrophy. When this compensatory mechanism is exhausted, LV function decreases
What are the key presentations of AS?
Angina, syncope, heart failure, dyspnoea
Describe some common signs of AS
Ejection systolic crescendo decrescendo murmur, narrow pulse pressure
What is the gold standard investigation?
Echocardiogram
What would you find on an echocardiogram?
LV size and function (incl LVH, dilation and EF), Doppler derived pressure gradient and valve area
What other investigations could you do?
ECG, CXR, Cardiac catheter
What differential diagnoses are there?
Hypertrophic cardiomyopathy, aortic sclerosis
What is the definitive treatment?
Surgical replacement, TAVI if not fit for surgery
What other things could you do?
Consider IE prophylaxis in dental procedures
What indicates treatment is necessary?
Any symptoms, decreasing EF, CABG with moderate/severe AS
