Aortic Stenosis Overview

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Questions and Answers

What is the definition of Aortic stenosis?

A condition characterized by the dilation of the aortic valve.

Narrowing of the aortic valve obstructing blood flow during diastole.

Narrowing of the aortic valve obstructing blood flow from the left ventricle to the ascending aorta during systole. (correct)

Thickening of the aortic valve leading to decreased blood flow.

Which age group is most commonly affected by Aortic stenosis?

30 to 50 years old

50 to 70 years old

Under 30 years old

Over 70 years old (correct)

Which of the following is NOT a clinical feature of Aortic stenosis?

Palpitations (correct)

Dyspnea

Angina

Syncope or lipothymia

What is the characteristic pulse pattern associated with Aortic stenosis?

Pulsus parvus et tardus Signup and view all the answers

What is the normal aortic area measurement?

3 cm² Signup and view all the answers

What symptom is reported by approximately 50% of patients with Aortic stenosis?

Dyspnea Signup and view all the answers

What is a common cause of Aortic stenosis in older adults?

Degenerative calcification Signup and view all the answers

What percentage of angina cases in Aortic stenosis are functional, as opposed to organic?

75% Signup and view all the answers

What is the recommended management for asymptomatic patients with severe aortic stenosis?

Regular follow-up every 6 months Signup and view all the answers

Which of the following could be a complication of aortic stenosis?

Systemic cardiac embolism Signup and view all the answers

What is the first-line treatment for heart failure associated with rheumatic etiology in aortic stenosis?

Diuretics Signup and view all the answers

When is transcatheter aortic valve implantation (TAVI) indicated?

In inoperative patients at high risk Signup and view all the answers

Which of the following is NOT an indication for surgical intervention in aortic stenosis?

Asymptomatic but severe with normal exercise test Signup and view all the answers

What type of prosthesis is typically recommended for younger patients requiring surgical valve replacement?

Mechanical prosthesis Signup and view all the answers

What is a characteristic hallmark of aortic stenosis during physical examination?

Crescendo-decrescendo ejection murmur Signup and view all the answers

Which of the following is a common etiology of aortic stenosis?

Congenital bicuspid valve Signup and view all the answers

What is the hallmark finding of aortic stenosis during auscultation?

A crescendo-decrescendo ejection murmur Signup and view all the answers

What is indicated by a mean gradient of LV-AO greater than 40 mmHg?

Severe aortic stenosis Signup and view all the answers

What condition is suggested by enlargement of the vena cava in the context of right heart impact?

Tricuspid Regurgitation Signup and view all the answers

Which of the following factors indicates a bad prognosis for patients experiencing symptoms of aortic stenosis?

Heart failure with a life expectancy of 6 months Signup and view all the answers

What echocardiography finding indicates severe aortic stenosis?

Aortic area < 2 cm² Signup and view all the answers

What condition is associated with rapidly worsening aortic stenosis?

Congenital aortic stenosis with extensive calcifications Signup and view all the answers

Which diagnostic test is typically done before Transcatheter Aortic Valve Implantation (TAVI)?

Coronary angiography Signup and view all the answers

During a chest X-ray of a patient with aortic stenosis, what abnormality can be observed?

Dilation of the aorta Signup and view all the answers

Study Notes

Aortic Stenosis (AS)

Definition: Narrowing of the aortic valve, obstructing blood flow from the left ventricle to the aorta during systole.
Prevalence: More common after 70 years old.
Normal aortic area: 3 cm²
Severe AS: Aortic area < 1 cm²

Etiology

Degenerative sclerosis with calcification: Most common.
Congenital bicuspid valve: Common.
Rheumatic fever: Common in underdeveloped countries.
Other causes: Idiopathic, Monckeberg disease, and fibromuscular dysplasia.

Pathophysiology of Aortic Stenosis

Increased afterload: The narrowed valve increases resistance against blood flow from the left ventricle, increasing workload on the heart.
Left ventricular hypertrophy: Increased workload leads to enlargement of the left ventricle, resulting in a thickened heart wall.
Reduced cardiac output: Less blood is pumped out during each beat due to the narrowed valve, which can lead to fatigue and shortness of breath.

Clinical Features

Triad of symptoms:
- Dyspnea: Shortness of breath.
- Angina: Chest pain.
- Syncope: Fainting.
Physical examination:
- Pulse: Reduced amplitude and slow rising (pulsus parvus et tardus).
- Thrill: Palpable vibration felt over the heart.
- Murmur: Crescendo-decrescendo ejection murmur heard best at the right and left upper sternal borders.

Diagnosis

Electrocardiogram (ECG): May show left ventricular hypertrophy.
Chest X-ray: May show dilatation of the aorta, but often normal.
Echocardiography: The gold standard for diagnosis:
- Measures the aortic valve opening and morphology.
- Determines severity of stenosis by calculating the gradient & aortic area.
- Evaluates left ventricular hypertrophy and function.
- Identifies associated lesions.

Management

Asymptomatic AS: Requires no treatment, but regular follow-up every 6 months is recommended.
Symptomatic AS: Surgery is the only therapeutic option.
- Surgical Valve Replacement:
  - Bioprosthesis: Preferred for elderly patients, as it does not require anticoagulation.
  - Mechanical Prosthesis: Used for young patients with long life expectancy.
- Transcatheter Aortic Valve Implantation (TAVI): Preferred for high-risk patients unsuitable for surgery.
  - Operative Risk: Surgical risk should be assessed for all patients.

Outcome

Progression: AS is a progressive disease.
Symptomatic Outcome:
- Angina: 5-year life expectancy.
- Syncope: 5-year life expectancy.
- Dyspnea: 2-year life expectancy.
- Heart failure: 6-month life expectancy.
Complications:
- Arrhythmias.
- Cardiac conduction disturbances.
- Left heart failure.
- Systemic cardiac embolism.
- Infective endocarditis.
- Sudden death.

Prevention

Primary prevention: Control risk factors for heart disease, such as high blood pressure, high cholesterol, and smoking.
Secondary prevention: Prophylaxis for rheumatic fever.

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Description

This quiz explores the definition, prevalence, etiology, and pathophysiology of Aortic Stenosis (AS). It covers key concepts such as the normal aortic area and the implications of severe AS. Test your knowledge on how AS affects the heart and its function.