Aortic stenosis

Aortic stenosis

• chest pain
• dyspnoea
• syncope / presyncope (e.g. exertional dizziness)
  syncope / presyncope (e.g. exertional dizziness)
  You've never been tested on this concept
  You've not yet rated this concept.
• murmur
  • an ejection systolic murmur (ESM) is classically seen in aortic stenosis
  • classically radiates to the carotids
  • this is decreased following the Valsalva manoeuvre
    Valsalva manoeuvre
    You've never been tested on this concept
    You've not yet rated this concept.

• narrow pulse pressure
  Aortic stenosis - narrow pulse pressure
  You've never been tested on this concept
  You've not yet rated this concept.
  Importance: 37
• slow rising pulse
  Aortic stenosis - slow rising pulse
  You've never been tested on this concept
  You've not yet rated this concept.
  Importance: 9
• delayed ESM
• soft/absent S2
  Aortic stenosis - a soft S2 is a feature of severe disease
  You've never been tested on this concept
  You've not yet rated this concept.
  Importance: 34
• S4
  Aortic stenosis - S4 is a marker of severity
  You've never been tested on this concept
  You've not yet rated this concept.
  Importance: 56
• thrill
• duration of murmur
• left ventricular hypertrophy or failure

• degenerative calcification (most common cause in older patients > 65 years)
• bicuspid aortic valve (most common cause in younger patients < 65 years)
• William's syndrome (supravalvular aortic stenosis)
• post-rheumatic disease
• subvalvular: HOCM

• if asymptomatic then observe the patient is a general rule
• if symptomatic then valve replacement
  Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
  You've never been tested on this concept
  You've not yet rated this concept.
  Importance: 70
• if asymptomatic but valvular gradient > 40 mmHg
  Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
  You've never been tested on this concept
  You've not yet rated this concept.
  Importance: 70
  and with features such as left ventricular systolic dysfunction then consider surgery
• options for aortic valve replacement (AVR) include:
  • surgical AVR is the treatment of choice for young, low/medium operative risk patients
    Symptomatic aortic stenosis: surgical AVR for low/medium operative risk patients
    You've never been tested on this concept
    You've not yet rated this concept.
    Importance: 48
    . Cardiovascular disease may coexist. For this reason, an angiogram
    angiogram
    You've never been tested on this concept
    You've not yet rated this concept.
    is often done prior to surgery so that the procedures can be combined
  • transcatheter AVR (TAVR) is used for patients with a high operative risk
    Symptomatic aortic stenosis: transcatheter AVR for high operative risk patients
    You've never been tested on this concept
    You've not yet rated this concept.
    Importance: 97
• balloon valvuloplasty
  • may be used in children with no aortic valve calcification
  • in adults limited to patients with critical aortic stenosis who are not fit for valve replacement