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Aortic Stenosis (AS)

Etiology

  • Infants, children, adolescent
  • Young adults to middle-aged
    • Calcification and fibrosis of a congenitally bicuspid valve
    • Rheumatic aortic Stenosis
  • Elderly
    • Senile Calcification (MCC of AS)
    • Rheumatic AS

Pathogenesis

  • Obstructed LV emptying leads to ↑LVP – causing LVH (ECG changes show Tall R waves, SV1 +RV5 = >35mm)
  • Obstruction to LV outflow becomes more severe on exercise
    • In AS, cardiac output hardly increases during exercise
    • Results in ↓BP and coronary ischemia worsens
  • Eventually, LV can no longer overcome outflow tract obstruction
    • Results in pulmonary oedema
  • In contrast to pts with MVS, pts with AS remain asymptomatic or years but deteriorate rapidly when sx develop
    • Death within 3-5 years of symptoms

Clinical features

  • 3 cardinal symptoms – angina, breathlessness, syncope
  • Harsh ejection systolic murmur
  • Slow rising carotid pulse
  • Thrusting apex beat – due to LV pressure overload

Diagnosis

ECG – ‘LLL’

  • LV hypertrophy
    • LV strain – ST dep and T wave inversion in II, III, aVF, V5, V6
    • ↑QRS amplitude and tall R waves
  • LBBB
  • Left axis deviation

Echo (diagnostic) – shows restricted valve opening

Doppler – shows the pressure gradient across the valve

Cardiac catheterisation

  • To identify associated coronary artery disease

Treatment

  • Keep asymptomatic patients under review for development of angina, syncope and dyspnoea
  • Aortic valve replacement – for pts with symptomatic severe AS
  • Anticoagulants – for patients who have AF
  • Balloon dilation
  • Prophylactic antibiotics for infective endocarditis
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