Scribd Logo
Upload

Welcome to Scribd!

  • 52 views

    Aortic Stenosis: Sherif EL Hawary, MD

    Uploaded by

    Syximsh FP
    The document discusses aortic stenosis (AS). It begins by summarizing a case of congenital AS in a patient. It then answers questions about AS, covering causes, types, clinical presentation, examination findings, complications, investigations and management. The most common causes of AS are rheumatic fever, congenital defects and calcification. The main symptom is angina and syncope. Examination may reveal a systolic thrill and murmur. Echocardiography is the most important investigation. Surgery is indicated for severe AS based on symptoms and valve area/gradient.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Aortic Stenosis: Sherif EL Hawary, MD

    Uploaded by

    Syximsh FP
    52 views6 pages
    The document discusses aortic stenosis (AS). It begins by summarizing a case of congenital AS in a patient. It then answers questions about AS, covering causes, types, clinical presentation, examination findings, complications, investigations and management. The most common causes of AS are rheumatic fever, congenital defects and calcification. The main symptom is angina and syncope. Examination may reveal a systolic thrill and murmur. Echocardiography is the most important investigation. Surgery is indicated for severe AS based on symptoms and valve area/gradient.

    Original Title

    AS.doc

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses aortic stenosis (AS). It begins by summarizing a case of congenital AS in a patient. It then answers questions about AS, covering causes, types, clinical presentation, examination findings, complications, investigations and management. The most common causes of AS are rheumatic fever, congenital defects and calcification. The main symptom is angina and syncope. Examination may reveal a systolic thrill and murmur. Echocardiography is the most important investigation. Surgery is indicated for severe AS based on symptoms and valve area/gradient.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    52 views6 pages

    Aortic Stenosis: Sherif EL Hawary, MD

    Uploaded by

    Syximsh FP
    The document discusses aortic stenosis (AS). It begins by summarizing a case of congenital AS in a patient. It then answers questions about AS, covering causes, types, clinical presentation, examination findings, complications, investigations and management. The most common causes of AS are rheumatic fever, congenital defects and calcification. The main symptom is angina and syncope. Examination may reveal a systolic thrill and murmur. Echocardiography is the most important investigation. Surgery is indicated for severe AS based on symptoms and valve area/gradient.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 6

    1

    AORTIC STENOSIS

    Question:
    - What is your diagnosis??

    Answer:

    - Congenital heart disease.


    - Aortic valve disease, aortic stenosis.
    - Compensated on treatment.
    - Not complicated.

    Question:
    - Why did you diagnose the aetiology as Congenital heart disease??
    Answer:
     There is absent history of Rheumatic Fever RF.
     There is history of positive consanguinity.
     The onset of the disease started early in childhood.

    Question:
    - What is the most common cause of AS ??
    Answer:
    - Rheumatic Fever, Congenital, Calcific.

    Question:
    - What are the other causes of AS that you know??
    Answer:
    Hypertrophic cardiomyopathy (Idiopathic hypertrophic subaortic stenosis ; IHSS):
    - It produces a subvalvular obstruction in the systole due to the contraction of the
    hypertrophied interventricular septum.

    Relative stenosis (not an organic stenosis):


    a) Dilatation of the aorta:
    Hypertension, atherosclerosis & aortic aneurysm.
    b) Increased blood flow across the aortic valve: Hyperdynamic circulation, AR.

    Question:
    - What are the types of congenital AS that you know??
    Answer:
    - It may be: valvular, subvalvular or supravalvular.

    Sherif EL Hawary, MD
    2

    Question:
    - How could you differentiate between the 3 main causes of AS ??
    Answer:

    Congenital Rheumatic Calcific


    Age Young Middle Old
    History of RF Absent Present Absent
    Type Valvular or subvalvular Valvular Valvular
    or supravalvular
    Associations Congenital anomalies Other valvular lesions Atherosclerosis

    Question:
    - Why did you diagnose the case clinically as AS lesion??
    Answer:
    - Because there is clinical evidence of AS in the form of:

    From history
    - Symptoms of low CO ( dizziness, blurring of vision ). - Angina & exertional syncope.
    _____________________________________________________________________________

    From general examination:


    ___________________________________________________________________________________________________________________
    - Slight pallor.
    - Pulse: weak (small volume), plateau.
    - BP: low systolic.
    - Neck:
    o Neck veins: normal.
    o Carotid arteries: systolic thrill originating from the base of the heart.
    From precordial examination
    - Signs of LV enlargement.
    - Heaving apex.
    - Systolic thrill over the second right space propagated to the carotid.

    From auscultation
    - Over the aortic area:
    1. Second heart sound: weak.
    2. Systolic ejection click: due to opening of the rigid cusps.
    3. Systolic ejection murmur:
    - Midsystolic, harsh, grade IV.
    - Maximum over the second right space & propagated to the apex & carotid arteries.
    - Over the pulmonary area: Reversed splitting of the second hesrt sound.
    - Over the mitral area:
    1. Propagated murmur of aortic stenosis.
    2. S4.

    Sherif EL Hawary, MD
    3

    Question:
    - What is the main presenting symptom of AS ??
    Answer:
    - Symptoms of low CO especially Angina & exertional syncope.

    Question:
    - Why is S2 weak in the patient with AS??
    Answer:
     Due to presence of low pressure over the aortic cusps which will close weakly.

    Question:
    - What do you expect to find in examination of the pulse in AS ??
    Answer:
    - Pulsus parvus et tardus (plateau pulse): rises slowly, of small volume, returns
    slowly.
    - Pulsus bisferiens: bifid pulse occurring in double aortic lesion with predominant AR.

    Question:
    - How do you explain the presence of bradycardia in a patient with AS ??
    Answer:
    - Complication by heart block that may occur in patients with calcific AS due to extension of
    calcification to the AV bundle.

    Question:
    - What causes angina in AS ??
    Answer:
    - Reduced coronary blood flow: due to low CO & shortened diastole.
    - Left ventricular hypertrophy: increases the myocardial O2 demands.
    - Associated coronary aterosclerosis: especially in calcific AS.

    Question:
    - What are the valvular diseases that present with angina ??
    Answer:
    - AS & AR.

    Question:
    - In which condition is S2 normal in AS ??
    Answer:
    - In cases of AS which are associated with AR (double aortic).

    Question:
    - What additional sound can you hear in AS ??
    Answer:
    - Systolic ejection click: due to opening of the rigid cusps.

    Sherif EL Hawary, MD
    4

    Question:
    - What can you hear over the mitral area in this patient ??
    Answer:
    1. S4.
    2. Propagated murmur of aortic stenosis.

    Question:
    - What can you hear over the pulmonary area in this patient ??
    Answer:
    - Reversed splitting of the second heart sound.

    Question:
    - What type of heart failure can occur in AS, left-sided or right-sided??
    Answer:
    - Left-sided heart failure due to left ventricular failure & pulmonary congestion.. However,
    Right-sided heart failure can also occur late secondary to left-sided heart failure.

    Remember: Left-sided heart failure is the most common cause of Right-sided heart failure.

    Question:
    - What other complications of AS do you know ??
    Answer:
    1. LVF.
    2. Infective endocarditis.
    3. Sudden death: usually due to VF.
    4. Heart block: in calcific stenosis due to extension of calcification to the AV bundle.
    5. Rheumatic activity: in rheumatic AS.

    Question:
    - What is the most important investigation of AS ??
    Answer:
    - Echo cardiography.
    Question:
    - What do you expect to find in the chest x-ray of a patient with AS ??
    Answer:
    - No abnormality: in mild cases.
    - LV: LVH.
    - Lungs: Pulmonary congestion when LVF occurs.
    - Small aortic knuckle or post-stenotic dilatation.
    - Aortic valve calcification may be seen.

    Sherif EL Hawary, MD
    5

    Question:
    - What do you expect to find in the ECG of a patient with AS ??
    Answer:
    - Left ventricular enlargement.

    Question:
    - How would you proceed to manage this case??
    Answer:
    1. I would ask for echocardiography to prove my diagnosis of aortic stenosis lesion.
    2. I would then start treatment which could be:
    - medical or - surgical ( refer to the book ).

    Question:
    - When would you ttt this patient surgically ??
    Answer:
    - Indications of surgery in AS: (aortic valve replacement):
    1. Presence of symptoms.
    2. Pressure gradient more than 50 mmHg.
    3. Valve area less than 0.8 cm2 ( normally: 3-4 cm2 ).

    Most important points in pure Aortic Stenosis

    ▪ The most common cause is: Rheumatic Fever, Congenital, Calcific.


    ▪ The most common symptom is: Angina & syncope.
    ▪ The most important precordial sign is: systolic thrill over the second right space.
    ▪ The most important auscultatory sign is: systolic ejection murmur over the second right space.

    Sherif EL Hawary, MD
    6

    Sherif EL Hawary, MD

    You might also like