Aortic Stenosis

Question 1

MCC of AS

Answer 1

progressive calcification of normal trileaflet valve

Question 2

usual age of dx of AS

Answer 2

60 yoa or more

Question 3

when do pts w/ congenital bicuspid aortic valve usually present?

Answer 3

40-60 yoa

Question 4

cardinal sxs of AS

Answer 4

• HF
• angina
• syncope

Question 5

heart sound/murmur heard in AS

Answer 5

• midsystolic murmur at upper right 2nd ICS
• murmur radiates to carotid arteries
• decreased intensity of S2

Question 6

carotid pulse in AS

Answer 6

delayed, low-amplitude (pulsus parvus et tardus)

Question 7

CXR findings in AS

Answer 7

• boot-shaped cardiac silhouette

- poststenotic aortic dilatation

Question 8

echo findings in AS

Answer 8

• LAE
• LVH
• calcified aortic valve leaflets w/ restricted motion

Question 9

SEVERE AS a/w valve area and mean transvalvular gradient of?

Answer 9

• < 1 cm2

- > 40 mmHg

Question 10

AS in setting of GIB (rare)

Answer 10

Heyde syndrome

Question 11

pathophysiology of Heyde syndrome

Answer 11

acquired vWD

Question 12

DON’T BE TRICKED

when is transvalvular gradient significantly UNDERestimated?

Answer 12

decreased LV function

Question 13

DON’T BE TRICKED

when should you avoid an EST in a pt w/ AS?

Answer 13

symptomatic AS

Question 14

treatment of choice for most pts w/ symptomatic severe AS

Answer 14

surgical aortic valve replacement

Question 15

when is transcatheter aortic valve replacement (TAVR) the tx of choice?

Answer 15

HIGH-risk pts who are NOT surgical candidates

Question 16

CONTRAINDICATIONS to TAVR

Answer 16

• bicuspid aortic valve
• significant AR
• mitral valve dz

Question 17

tx for AS until surgery or TAVR

Answer 17

diuretics, digoxin, ACEI, +/- nitrates (may not tolerate)

Question 18

DON’T BE TRICKED

what tx should NOT be done for AS?

Answer 18

balloon valvuloplasty

Question 19

DON’T BE TRICKED

what med should NOT be given to pts w/ AS and HF?

Answer 19

BB

Question 20

DON’T BE TRICKED

what medication does NOT change the natural h/o AS?

Answer 20

statins

Question 21

how often to get echos in Asymptomatic pts w/ SEVERE AS?

Answer 21

yearly

Question 22

how often to get echos in Asymptomatic pts w/ MODERATE AS?

Answer 22

every 1-2 years

Question 23

how often to get echos in Asymptomatic pts w/ MILD AS?

Answer 23

every 3-5 years