aortic stenosis

Question 1

Progression

Answer 1

slowly progressive

by the time clinically significant, valve is usually heavily calcified

Question 2

Epidemiology

Answer 2

male predominance

Question 3

3 main causes:

Answer 3

1. congenitally anomalous bicuspid valve (50%)
2. “senile” degeneration
3. chronic rheumatic disease

Question 4

If pt presents before age 65…

Answer 4

probably bicuspid valves

Question 5

if pt presents over the age of 65…

Answer 5

probably senile degeration

Question 6

When aortic valve opening is less than 50% of normal size…

Answer 6

• -significantly increased LV pressure necessary to push SV through
• -concentric LV hypertrophy (like HTN heart disease)…accompanying decrease in compliance

Question 7

Pathogenesis

Answer 7

early:
-valve thickening w/ lipid deposition and inflammation
–fibrosis
Late:
–nodular heaped-up calcifications in mid-portion of each cusp, protruding into sinuses of Valsalva

Question 8

Symptoms

Answer 8

• -angina pectoris (chest pain due to myocardial ischemia)
• -syncope
• -dyspnea

symptoms usually occur w/ exertion

Question 9

Signs

Answer 9

• -crescendo-decrescendo systolic (ejection) murmur
• -weak delayed pulse
• -atrial gallop

Question 10

Onset of symptoms indicates…

Answer 10

high risk of death w/in 5 yrs

time for surgical valve replacement (greatly improves survival)