Aortic Stenosis is the narrowing of the three cusps that form the aortic valve. It is distinct from aortic sclerosis which is generally a milder precursor to aortic stenosis.
Aortic Stenosis is typically progressive, with symptoms becoming gradually worse over time. The first presentation usually occurs with shortness of breath on exertion.
- Bicuspid Valve
- Williams Syndrome
- THE most common cause
- Look for corneal arcus
- Ejection Systolic murmur best heard in the aortic area, ( Right 2nd intercostal space at border of sternum), radiating to the caroitds.
- Slow-rising pulse, with a narrow pulse pressure (difference between systolic and diastolic pressures is small)
- Heave – but apex beat is not displaced
- Possible signs of:
- Signs of any valve defect
- L – LBBB – due do calcification
- L – Left Axis Deviation
- L – LVH
- P – Poor R wave progression (i.e. depolarisation of the ventricles is slow)
Used to estimate the pressure across the valve.
- 0 mmHg – normal valve
- <30 mmHg – mild aortic stenosis
- 30-50 mmHg – moderate aortic stenosis
- >50 mmHg – severe aortic stenosis
This can assess the actual gradient across the valve as well as check for co-existing CAD
- Angina present – 2 years
- Syncope present – 1 year
- Dyspnoea present – 6 months
- Surgical –if symptomatic, then the prognosis is poor (above) and prompt valve replacement is recommended. Valve replacement is also recommended for patients with ECG signs, and moderate to severe disease on Doppler / cardiac catheterisation.
- Patients should be placed on antibiotics to prevent bacterial endocarditis
Prosthetic – last about 10 years, after which time, may require another replacement. No need for long term anticoagulant therapy.
Metal –last a life time, but require anticoagulant therapy for life. Also noisy (often make a loud ‘click’ sound). There are three types of metal valve
- Tilting disc
- Double tilting disc
- Ball in a cage