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Title: Aortic Stenosis (AS) - Clinical Summary
Description: This provides a summary of AS as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
Description: This provides a summary of AS as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
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AORTIC STENOSIS
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Presentation
A classical triad is described, ‘SAD’
S – syncope (exertional)
A – angina
D – dyspnoea
Seen in around 40-50% of patients
...
It can also lead to acquired von Willebrand deficiency and clotting abnormalities
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§ Most common cause in western world is calcification of aortic valve
§ Calcification (degenerative) (80%)
o Caused by inflammation and progressive calcification
o Limits movement of aortic valve
o Affects patients later in life (>65)
o Risk factors ® hypercholesterolaemia, hypertension, smoking, diabetes
§ Bicuspid valve (congenital) (1-2%)
o Most common congenital abnormality of heart
o Males more commonly affected
o Valves are predisposed to become stenotic
o Stenosis appears at younger age (<65)
o Abnormal heart valves ® turbulent flow with subsequent fibrosis and calcification
§ Rheumatic heart disease
o Autoimmune condition following Streptococcal (group A) infection
o Inflammation results from molecular mimicry
o Affected tissues: heart, joints, CNS
o Becoming more uncommon over time
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Investigation
Echocardiogram is the main diagnostic method
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ECG
§ May see: left ventricular hypertrophy
o Deep S-waves in V1 and V2
o Tall R waves in V5 and V6
§ Left ventricular strain may be seen in severe disease
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Echocardiogram
§ Assess valve area, ejection fraction, ventricular hypertrophy
§ Classified by severity on echo according to its transaortic pressure gradient and valve area
Other Tests
§ Cardiac MRI
§ Cardiac catheterisation
§ ECG exercise stress testing ® in asymptomatic patients
o Positive test = onset of symptoms, ECG changes, abnormal BP response
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Valvotomy
§ Stenotic valve leaflets are forced apart
§ May be: percutaneous balloon valvotomy or open valvotomy
...
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Title: Aortic Stenosis (AS) - Clinical Summary
Description: This provides a summary of AS as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
Description: This provides a summary of AS as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.