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Aortic valve stenosis
This document discusses aortic stenosis (AS) across different age groups and etiologies. It covers symptoms, physical exam findings, diagnostic criteria based on valve area and gradients, and indications for intervention. AS presents asymptomatically in early stages but can progress to cause angina, syncope and dyspnea from increased left ventricular pressure and reduced coronary flow. Physical exam may reveal delayed upstroke of the pulse and apical impulse. Diagnosis is made using echocardiography to measure valve area and gradients. Guidelines recommend intervention for severe AS or worsening symptoms.
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Aortic valve stenosis
- 1. T&M Medical SoftwareSolutions, Inc. All Rights Reserved
- 2. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Young age Middle age 40 - 50 Thick congenital bicuspid Rarely • Unicuspid • Supravalvular • subvalvular • Thick degenerative valve • Calcified congenital biscuspid valve • Rheumatic fever Old age 60 - 80 • Thick bicuspid valve • Rheumatic disease
- 3. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Valvular Subvalvular Supravalvular Rheumatic fever Degenerative Biscuspid Subaortic membrane HOCM
- 4. T&M Medical SoftwareSolutions, Inc. All Rights Reserved AS Pressure overload of LV LVESP > Ao. Systolic pressure LV hypertrophy Reduced LV compliance leads to diastolic dysfunction and increased LVEDP Increased myocardial oxygen requirement Reduced coronary blood flow leads to angina
- 5. T&M Medical SoftwareSolutions, Inc. All Rights Reserved AS is a progressive disease and patients remains asymptomatic for years Symptoms Angina Syncope Dyspnoea ++ O2 demand ++ LVEDP -- CO due to LVOT ++ LVEDP and LAP with pulmonary congestion
- 6. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Pulsus Tardus (slow rising pulse) Parvus (small amplitude pulse) Sustained Apical impulse Due to prolonged left ventricular ejection
- 7. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Heart Sound Valvular AS Other causes S2 diminished or absent Single or split Ejection click no calcification 4th sound (Apex) Normal S2 in HOCM ++ S2 in cong. Valvular AS Ejection click absent
- 8. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Murmur Valvular AS Max. intensity: A1 Propagation :root of the neck, Apex, carotid HOCM—A2 Tri leflet AS – Apex (Gallaverdin sign) Supravalvular – Rt infraclavicular Mid to late systolic Thrill: A1 Short and peaks earlier Character: Harsh Contour: Crescendo - decrescendo Soft if functional Musical if pliable and calcific Timing: Midsystolic
- 9. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Mild Moderate Severe Aortic valve area (cm2) 1.5 – 2.5 1.0 – 1.5 <1.0 Mean pressure gradient (mmHg) 15 - 25 25 - 40 > 40 Peak Velocity (m/s) < 3.0 3 – 4 >4
- 10. T&M Medical SoftwareSolutions, Inc. All Rights Reserved Severe > 40 mmHg Moderate 20 – 40 mmHg Symptomatic Class IIAClass IIBClass IIAClass I Asymptomatic Symptomatic Asymptomatic LVEF < 50 % Other cardiac surgery > 60 mmHg Abnormal ETT ∆ in velocity > 0.3 m/s/y And other cardiac operations LVEF < 50 % Yes No DSE Ao. Valve area < 1cm2 Ao. Flow > 4 m/s AVA < 1cm2 & LVEF > 50 %
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