Aortic Stenosis

Pathology:                    

Narrowed aortic valve orificeleading to LV pressure overload and causing Left Ventricular Hypertrophy, Left VentricularFailure, pulmonary oedema and Chronic Heart Failure

Aetiology:                    

Congenital: bicuspid valve causingcalcified degeneration or congenital AS

Acquired:

‍degenerative calcified AS (mostcommon), “wear and tear”, rheumatic heart disease

Symptoms:                  

Exertional angina, dyspnoea,syncope, signs & symptoms of CHF if severe (pulmonary oedema, congestivehepatomegaly)

Signs:                              

Pulse: narrow pulse pressure, brachialradial delay, slow rising pulse

Chest: heaving, displaced apex beat, ejectionsystolic murmur radiating to

carotids and heard loudest over aorticvalve area Soft S2 with splitting of

S2 in severedisease, 4^th heart sound

Investigations:          

ECG: Left Ventricular Hypertrophy, LBBB,Left Atrial Enlargement, AF

Chest X-Ray: Post-stenotic aortic rootdilatation, calcified valve, Left Ventricular

Hypertrophy + Left Atrial Enlargement, Chronic Heart Failure

Echo: Assessseverity by looking at Valvular area and pressure gradient, Left

VentricularHypertrophy and LV function


Cardiac catheterisation: exclude CAD or inconclusive ECHO

Treatment:                  

‍Medical: Symptom control – Diuretics, Beta-blockers

Surgical: Aortic valve replacement

Complications:          

Ventricular dysrhythmias, sudden death,heart block, prosthetic valve failure

Prognosis:                    

Untreated, symptomaticpatients have high mortality rate

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