Aortic Sclerosis

Question 1

Definition?

Answer 1

Thickening and calcification of the aortic valve without an obstruction of the ventricular flow of blood

Question 2

RF?

Answer 2

Older
HT
Renal disease
Smoking
LDL Levels
Diabetes
Metabolic syndrome

Question 3

ddx?

Answer 3

• Aortic stenosis-flow obstructed and mobility of valves is reduced
• Hypertrophic cardiomyopathy-hypertrophy of LV wall
• Mitral regurgitation-jet on echo
• Presence supra or sub levels

Question 4

aetiology?

Answer 4

• Lipid accumulation
• Inflammation
• Calcification
• Mechanical stress
Genetics-SNP of lipoprotein, NOTCH1 and osteoblast cells of valve; oestrogen a  gene in post-menopausal women

Question 5

CP?

Answer 5

Asymptomatic

Systolic ejection murmur in mid-systole

Question 6

pathophysiology?

Answer 6

• AS but of valve
• Osteoblast/clasts act as macrophages and take up excess lipid and become foam cell, and generate chronic inflammation and fibrosis
• Calcium is deposited onto the fibrous cap, causing sclerosis
Apolipoprotein B and E accumulate in the lining of the aortic valve and become oxidised , which destroys the lining and causes inflammation

Question 7

Investigations

Answer 7

• First line: CVS exam-see CP
• Second line:
• Transthoracic echo
Surface and centre of valves show echogenicity-mobility and velocity of valve is unaffected

Question 8

Management?

Answer 8

• First line: RF management

* Second line: lipid lowering therapies, calcium supplements if OP

Question 9

Prognosis?

Answer 9

• Aortic stenosis
• Aortic regurgitation
CVD