aortic stenosis

Question 1

when should cardiac catheterisation be done

Answer 1

when there is a concern about concomitant mitral valve disease

before surgery

Question 2

treatment for childhood

Answer 2

vagotomy

Question 3

other causes of valvular stenosis

Answer 3

• chronic kidney disease
• Paget’s disease of bone
• previous radiation exposure
• systemic lupus erythematosus

Question 4

what is murmur like

Answer 4

ejection systolic

crescendo-decresencdo

Question 5

what is most common cause

Answer 5

calcific aortic valvular disease (CAVD)

Question 6

what is most common form of congenital heart disease

Answer 6

bicuspid aortic valve

Question 7

what is CAVD

Answer 7

inflammatory process involving macrophages and T lymphocytes

Question 8

treatment for symptomatic patients

Answer 8

aortic valve replacement

Question 9

what does it include

Answer 9

• calcific stenosis of a trileaflet aortic valve
• stenosis of congenitally bicuspid valve
• rheumatic aortic stenosis

Question 10

what may be felt in the aortic area

Answer 10

systolic thrill

Question 11

signs

Answer 11

• sinus rhythm
• systolic thrill
• apex is non-displaced
• ejection click
• ejection systolic murmur

Question 12

symptoms

Answer 12

• chest pain
• breathlessness
• syncope
• pre-syncope
• fatigue

Question 13

who gets bicuspid aortic valve disease

Answer 13

new born babies

Question 14

what are other causes of obstruction to left ventricular emptying

Answer 14

• supravalvular obstruction
• subvalvular aortic stenosis
• hypertrophic cardiomyopathy

Question 15

what is supravalvular obstruction

Answer 15

congenital fibrous diaphragm above the aortic valve

Question 16

are extra heart sounds heard

Answer 16

yes S4

Question 17

where does murmur radiate to

Answer 17

carotids

Question 18

what is subvalvualr aortic stenosis

Answer 18

congenital condition in which the fibrous ridge or diaphragm is situated immediately below the aortic valve

Question 19

what calcifies in CAVD

Answer 19

lipoproteins

Question 20

where is murmur best heard

Answer 20

aortic area

Question 21

what is the pulse like

Answer 21

slow-rising

Question 22

what is seen on echo

Answer 22

• thickened, calcified aortic valve cusps
• left ventricular hypertrophy

used to determine severity

Question 23

what is done if patient is unfit for surgery

Answer 23

balloon dilatation but results are poor

Question 24

what does calcification reduce

Answer 24

systolic opening

Question 25

treatment for patients with BAV and enlarged ascending aorta

Answer 25

surgical intervention

Question 26

what is prognosis once symptoms occur

Answer 26

poor 2-3 years

Question 27

what is seen on CXR

Answer 27

- small heart - dilated aorta - aortic valve calcified

Question 28

what can rheumatic fever produce

Answer 28

progressive fusion, thickening and calcification of the aortic valve

Question 29

risk factors for CAVD

Answer 29

- old age - men - elevated lipoprotein and LDL - hypertension - diabetets - smoking

Question 30

what is supravalvular obstruction associated with (2)

Answer 30

- mental retardation | - hypercalcaemia

Question 31

what is bicuspid aortic valve associated with

Answer 31

- aortic coarctation - root dilatation - aortic dissection

Question 32

treatment for asymptomatic patients

Answer 32

regular review for assessment and echo

Question 33

what is done for diagnosis

Answer 33

- CXR - ECG - echo - cardiac catheterisation

Question 34

what is a novel treatment for patients unsuitable for surgical replacement

Answer 34

transcatheter implantation with a balloon expandable stent valve

Question 35

who usually gets CAVD

Answer 35

elderly

Question 36

what else is associated with rheumatic fever

Answer 36

mitral valve disease

Question 37

what does it produce

Answer 37

obstruction to the left ventricular stroke volume

Question 38

what does obstructed left ventricular emptying lead to

Answer 38

increased left ventricular pressure and compensatory left ventricular hypertrophy

Question 39

what does left ventricular hypertrophy lead to

Answer 39

ischaemia of the left ventricular myocardium - angina - arrhythmias - left ventricular failure

Question 40

what is seen on ECG

Answer 40

- left ventricular hypertrophy - left atrial delay - arrhythmias may be present