Aortic stenosis

Question 1

What is aortic stenosis?

Answer 1

Narrowing of the aortic valve, obstructing blood flow from the left ventricle to the aorta

Defined as narrowing from 3-4 cm² to < 1 cm².

Question 2

What are common causes of aortic stenosis?

Answer 2

• Calcification of leaflets
• Rheumatic heart disease
• Bacterial endocarditis
• Congenital malformations
• Congenital bicuspid aortic valve
• Hereditary cardiomyopathies

Non-calcific causes include rheumatic heart disease and congenital stenosis.

Question 3

What are the consequences of aortic stenosis?

Answer 3

• Pressure overload of left ventricle
• Concentric hypertrophy
• Reduced blood supply to peripheral organs
• Symptoms during exercise, later at rest
• Microangiopathic hemolytic anemia

Can lead to schistocytes and hemoglobinuria.

Question 4

List symptoms of aortic stenosis.

Answer 4

• Syncope
• Chest pain/angina
• Hemoglobinuria
• Exertional dyspnea
• Pulsus parvus et tardus

Pulsus parvus et tardus indicates a weak and late pulse.

Question 5

What is the treatment for aortic stenosis?

Answer 5

Valve repair or replacement

Surgical intervention is necessary for severe cases.

Question 6

What is aortic insufficiency?

Answer 6

Improper closing of the aortic valve, allowing blood to leak back into the left ventricle during diastole

This leads to volume overload of the left ventricle.

Question 7

What causes aortic insufficiency?

Answer 7

• Aortic root dilation
• Valvular damage from infective endocarditis
• Chronic rheumatic fever

Aortic root dilation can be due to aortic dissection or aneurysms.

Question 8

What are the consequences of aortic insufficiency?

Answer 8

• Volume overload of left ventricle
• Eccentric hypertrophy
• Diastolic pressure increase
• Systolic pressure increase
• Wide pulse pressure

Leads to symptoms like pulsus celer et altus and Quincke’s sign.

Question 9

What is coarctation of the aorta?

Answer 9

Localized narrowing in part of the aorta

Can occur in infantile (preductal) or adult (post-ductal) types.

Question 10

Describe the infantile type of coarctation of the aorta.

Answer 10

Narrowing occurs proximally to the ductus arteriosus, causing lower pressure in the aorta after the narrowing

Results in lower extremities cyanosis due to deoxygenated blood.

Question 11

What are the causes of infantile coarctation of the aorta?

Answer 11

Occurs during fetal development, often associated with congenital changes and Turner syndrome

Turner syndrome involves females with only one X chromosome.

Question 12

Describe the adult type of coarctation of the aorta.

Answer 12

Narrowing occurs distally to the ligamentum arteriosum, leading to higher pressure before and lower pressure after the narrowing

Causes hypertension and increases risk for berry aneurysms.

Question 13

What are the symptoms of adult coarctation of the aorta?

Answer 13

• Claudication
• Rib notching
• Hypertension

Rib notching occurs due to pulsation of posterior intercostal arteries.

Question 14

What is the treatment for coarctation of the aorta?

Answer 14

Balloon dilation and surgical removal of the narrowed part

This applies to both infantile and adult types.