Condition- Aortic Stenosis

Question 1

What is aortic stenosis?

Answer 1

A progressive narrowing of the left ventricular outflow at the level of the aortic valve

Question 2

Describe the general epidemiology of the disease and what might cause someone to present earlier?

Answer 2

Diseases of the elderly

If they have a bicuspid aortic valve- they present earlier

Question 3

What causes aortic stenosis?

Answer 3

• Calcification/ degeneration of Tricuspid aortic valve in the elderly
• Aortic stenosis secondary to rheumatic heart disease (most common worldwide but not western world)
• Congenital reasons: Calcification of congenital bicuspid aortic valve (common in Turner’s syndrome), William’s syndrome
• CKD (abnormal Ca2+ homeostasis)
• Connective tissue diseases

Question 4

What are the presenting symptoms of Aortic Stenosis?

Answer 4

• Exertional dyspnoea
• Exertional angina- because of increased oxygen deman of the hypertrophied left ventricle
• Syncope on exercise
• Symptoms of HF (dynspnoe, orthopnoea)

Question 5

Describe the signs of Aortic Stenosis

Answer 5

• Narrow pulse pressure
• Slow-rising pulse
• Thrill in aortic area
• May have heaves
• Ejection systolic murmur (LUB whoosh DUB)
• S2 diminished or absent due to calcification

Question 6

If a patient presented with an ejection systolic murmur over the aortic region as well as complaints of exertional dyspnoea and syncope what would be your suspected diagnosis and which investigations would you order to confirm this?

Answer 6

AORTIC STENOSIS

1. DOPPLER ECHO- to check gradient across valves. See elevated aortic pressure gradient
2. ECG
   
   1. Signs of left ventricular hypertrophy- ST depression and Inverted T waves in I, aVL and V5/V6
   2. Absent Q waves
   3. May have conduction disease= budle branch block etc
   4. Left axis deviation
3. CARDIAC MRI
4. CARDIAC ANGIOGRAPHY- to asses valve gradient