Aortic stenosis

Question 1

Define aortic stenosis

Answer 1

Narrowing of the left ventricular outflow at the level of the aortic valve

Question 2

Aetiology of aortic stenosis

3

Answer 2

Can be secondary to rheumatic heart disease (MOST COMMON WORLDWIDE)

Calcification of congenital bicuspid aortic valve

Calcification/degeneration of tricuspid aortic valve in the elderly

Question 3

Epidemiology of aortic stenosis

age, gender, bicuspid presentation

Answer 3

3% of 75 year olds
More common in males
Those w/ bicuspid aortic valve present earlier

Question 4

Presenting symptoms of aortic stenosis

4

Answer 4

May be initially ASYMPTOMATIC

Angina (due to inc. O2 demand of hypertrophied L ventricle)

Syncope or dizziness on exercise (due to outflow obstruction)

Symptoms of heart failure (e.g dyspnoea, orthopnoea)

Question 5

Signs of aortic stenosis on examination

7

Answer 5

• Narrow pulse pressure
• Slow rising pulse
• Thrill in the aortic area (only if severe)
• Forceful sustained thrusting undisplayed apex beat
• Ejection systolic murmur at aortic area, radiating to carotid artery
• 2nd heart sound may be softened or absent (due to calcification)
• Bicuspid valve may produce an ejection click

Question 6

Investigations for aortic stenosis

4 groups

Answer 6

ECG
CXR
ECHOCARDIOGRAM
CARDIAC ANGIOGRAPHY

Question 7

Investigations for aortic stenosis - ECG

2

Answer 7

Signs of L ventricular hypertrophy

• Deep S in V1/2
• Tall R in V5/6
• Inverted T waves in I, aVL & V5/6
• Left axis deviation

LBBB

Question 8

Investigations for aortic stenosis - CXR

2

Answer 8

• Post stenotic enlargement of ascending aorta

- Calcification of aortic valve

Question 9

Investigations for aortic stenosis - echocardiogram

3

Answer 9

• Visualises structural changes of valves & level of stenosis (valvar, supravalvar, subvalvar)
• Estimation of aortic valve area & pressure gradient across valve in systole
• Assess L ventricular function

Question 10

Investigations for aortic stenosis - cardiac angiography

2

Answer 10

• Allows differentiation from other causes of angina (e.g. MI)
• Allows assessment of concomitant coronary artery disease (50% have)