Aortic Stenosis
Definition: characterized by narrowing of the aortic valve orifice, producing obstruction to left ventricular outflow and compensatory concentric left ventricular hypertrophy
Causes
Progressive valvular calcification
Congenital valvular abnormalities
Rheumatic fever
Clinical features
Older pt
senile degenerative aortic stenosis
calcification of bicuspid valve
Hx
Assess risk factors
family history of valvular heart disease
Rheumatic fever? atherosclerosis?
Symptoms
Exertional dyspnoea
Angina, precipitated by exertion and relieved by rest
Exertional syncope
Acute pulmonary oedema
Signs
Delayed and diminished carotid pulses
abnormal heart sounds depending on the cause and extent of aortic valvular disease
ejection systolic murmur
slow-rising carotid pulse
thrusting apex beat (LV pressure overload)
Investigation
FBC
Cardiac enzyme
Serum electrolyte
ECG
LV hypertrophy
Left budle branch block
Echocardiograph
calcified valve with restricted opening
CXR
calcified valve
enlarged LV
dilated ascending aorta
DDx
HCOM
ACS
Angina pectoris
Management
Emergency: ABC
Medications
Antihypertensive: AS may result in hypertension
Vasodilators
goals of treatment in patients with aortic valvular stenosis are to relieve symptoms, improve cardiac hemodynamics and prevent progressive left ventricular dysfunction
Aspirin: prevent thrombolytic event
Aortic valve replacement