Cardiovascular System > Valvular Disease >
Aortic Stenosis
“Narrowing of the aortic valve, impeding delivery of blood from the LV to the body”
Risk Factors
- Age – valve calcification (most common)
- Congenital – Bicuspid valve
- Rheumatic fever
- Endocarditis
- Heart disease risk factors – hypercholesterolemia, HTN, smoking, insulin resistance, diabetes, overweight, lack of activity, family history
Aetiology
Valve doesn’t open fully → obstruction to ventricular emptying → early systolic murmur
NB. Pulmonary stenosis = same sounding murmur, in a different location and it doesn’t radiate
Pathophysiology
Pressure gradient develops between LV and aorta: LV function initially maintained through hypertrophy → LV function declines when compensatory mechanisms are exhausted
Clinical Presentation
- Symptoms
- Chest pain
- Weakness/dizziness –
presyncope / syncope - Dyspnoea
- HF → PND, orthopnoea, frothy sputum
- Signs
- Ejection systolic murmur → Heard on right 2nd intercostal space & radiates to carotid arteries
- Slow rising pulse
- Hypotension
- Pulsus bisferiens
Investigations
- Bloods:
- FBC, U+E, glucose, lipids
- Imaging:
- Chest X-Ray – Cardiomegaly (enlarged LV) / calcification of aortic ring
- Echocardiogram – Direct visualization of valve dysfunction, assess the severity of AS
- CT/MRI scan – more detailed image of heart and valves and assess the ascending aorta
- Special:
- ECG – LV hypertrophy / Left ventricular strain
Management
- Conservative:
- Smoking Cessation
- Dietary advice
- Medical:
- Statins
- Anti-hypertensives
- Anti-arrhythmic drugs
- Beta-blockers
- ACEi, diuretics
- Surgical:
- Valve replacement (mechanical or bioprosthetic)
- Transcatheter aortic valve implantation
- Balloon valvuloplasty