What is aortic stenosis?
Obstruction of blood flow across the aortic valve usually caused by senile calcification
What is the Mx aortic stenosis?
Percutaneous aortic balloon valvuloplasty
How is mitral regurgitation treated?
Depends on severity
Prophylaxis against endocarditis
Mitral valve repair or replacement
ACE Inhibitors, diuretics and possibly anticoagulants if surgery not possible
What are the classic signs and symptoms of aortic stenosis?
Chest pain: angina on exertion that is relieved by rest
Heart failure: with symptoms including paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and shortness of breath
Syncope: Often on exertion due to peripheral, arterial vasodilation leading to a drop in systemic BP due to having a fixed SV
Others: pulsus alternans, soft S2,
What are symptoms of mitral regurgitation?
(can be asymptomatic for years despite cardiac dimensions increasing)
Increases SV sensed as palpitation
Dyspnoea and orthopnoea
Fatigue and lethargy (due to reduced SV)
What Ix findings are present in mitral regurgitation?
CXR: LA and LV enlargement
ECG: Features of LA delay (bifid P waves)
Features of LV hypertrophy - tall R waves in left lat leads (leads 1 and V6) and deep S waves in the R-sided precordial leads (V1 and V2)
Echo: Dilated LA and LV
Severity of regurg can be assessed with doppler
What is the epidemiology of aortic stenosis?
Between 2-9% in elderly patients
What are the main causes of aortic stenosis?
Congenital unicuspid or bicuspid valves
Age related calcification
What are the signs of mitral regurgitation?
Pan-systolic murmur, mid-systolic click (due to prolapse of valve during systole)
Laterally displaced, forceful, diffuse apex beat and systolic thrill
Prominent third heart sound
What does degenerative (myxomatous) disease of the mitral valve commonly cause?
What are the Ix finding for aortic stenosis?
Measure aortic valve area on 2D echocardiogram
Measure transvalvular pressure gradient with a doppler echo
Aortic calcification is seen on CXR in patients with haemodymanically significant AS