Aortic stenosis (AS)

Aetiology:

There are 3 causes of AS:

• Congenital AS (develops progressively due to turbulent flow through a congenitally abnormal (usually bicuspid) aortic valve)
• Rheumatic fever
• Arteriosclerotic degeneration and calcification (through wear and tear)

Symptoms:

• Asymptomatic until AS is moderately severe (when the aortic orifice is reduced to 1/3 of its normal size
• Exercise induced:
• Syncope
• Angina
• Dyspnoea
• Sudden death

• When symptoms appear, the prognosis is poor – death occurs within 2-3 years without surgical intervention

Signs:

Pulse: Sinus rhythm, low volume, slow rising

Aortic area: Systolic thrill

Apex: Not displaced

Sounds: Ejection click, soft A2, S4

Murmur: Ejection systolic, radiates to the carotids

Investigations:

CXR:

• Relatively small heart
• Prominent, dilated ascending aorta

ECG:

• Left ventricular hypertrophy (left axis deviation)
• Usually sinus rhythm, but ventricular rhythms may occur

Echocardiography

Treatment:

• Pts should not over-exert themselves or take part in strenuous physical games
• Angina is best treated with ß-blockade (as GTN aggravates the exertional syncope)
• Antibiotic prophylaxis against IE is essential
• When severe, aortic valve replacement is recommended