Podcast
Questions and Answers
What is the definition of Aortic stenosis?
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?
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?
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?
What is the characteristic pulse pattern associated with Aortic stenosis?
What is the normal aortic area measurement?
What is the normal aortic area measurement?
What symptom is reported by approximately 50% of patients with Aortic stenosis?
What symptom is reported by approximately 50% of patients with Aortic stenosis?
What is a common cause of Aortic stenosis in older adults?
What is a common cause of Aortic stenosis in older adults?
What percentage of angina cases in Aortic stenosis are functional, as opposed to organic?
What percentage of angina cases in Aortic stenosis are functional, as opposed to organic?
What is the recommended management for asymptomatic patients with severe aortic stenosis?
What is the recommended management for asymptomatic patients with severe aortic stenosis?
Which of the following could be a complication of aortic stenosis?
Which of the following could be a complication of aortic stenosis?
What is the first-line treatment for heart failure associated with rheumatic etiology in aortic stenosis?
What is the first-line treatment for heart failure associated with rheumatic etiology in aortic stenosis?
When is transcatheter aortic valve implantation (TAVI) indicated?
When is transcatheter aortic valve implantation (TAVI) indicated?
Which of the following is NOT an indication for surgical intervention in aortic stenosis?
Which of the following is NOT an indication for surgical intervention in aortic stenosis?
What type of prosthesis is typically recommended for younger patients requiring surgical valve replacement?
What type of prosthesis is typically recommended for younger patients requiring surgical valve replacement?
What is a characteristic hallmark of aortic stenosis during physical examination?
What is a characteristic hallmark of aortic stenosis during physical examination?
Which of the following is a common etiology of aortic stenosis?
Which of the following is a common etiology of aortic stenosis?
What is the hallmark finding of aortic stenosis during auscultation?
What is the hallmark finding of aortic stenosis during auscultation?
What is indicated by a mean gradient of LV-AO greater than 40 mmHg?
What is indicated by a mean gradient of LV-AO greater than 40 mmHg?
What condition is suggested by enlargement of the vena cava in the context of right heart impact?
What condition is suggested by enlargement of the vena cava in the context of right heart impact?
Which of the following factors indicates a bad prognosis for patients experiencing symptoms of aortic stenosis?
Which of the following factors indicates a bad prognosis for patients experiencing symptoms of aortic stenosis?
What echocardiography finding indicates severe aortic stenosis?
What echocardiography finding indicates severe aortic stenosis?
What condition is associated with rapidly worsening aortic stenosis?
What condition is associated with rapidly worsening aortic stenosis?
Which diagnostic test is typically done before Transcatheter Aortic Valve Implantation (TAVI)?
Which diagnostic test is typically done before Transcatheter Aortic Valve Implantation (TAVI)?
During a chest X-ray of a patient with aortic stenosis, what abnormality can be observed?
During a chest X-ray of a patient with aortic stenosis, what abnormality can be observed?
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.
- Surgical Valve Replacement:
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.
