Tan Tao University

1. AORTIC STENOSIS
(AS)

2. Đinh Trần Xuân Trường
Nguyễn Ngọc Tú Quỳnh
Trần Thanh Tuấn
Trần Triển
Ngô Trung
Huỳnh Trọng Ân
Huỳnh An Khang
Đỗ Nhật Minh Trực
Nguyễn Hoàng Phi Yến
Members

3. 1. Anatomy and Physiology
2. Pathophysiology
3. Signs and Symptoms
4. Pharmacology
5. Investigation
6. Management
7. Discussion
Layout

5. Anatomy and Physiology

6. The abnormal narrowing of the aortic valve
Anatomy and Physiology

7. Congenital heart defect : 50% of cases
Aortic valve calcification : 30 -40% of cases
Rheumatic fever : less than 10% of cases
Pathophysiology

8. Congenital heart defect
 One leaflet (unicuspid)
 Two leaflets (bicuspid 27 - 50%)
 Four leaflets (quadricuspid)
Pathophysiology

9. Unicuspid
Quadricuspid
Bicuspid

10. The buildup of calcium deposits  narrow the valve
(30-40% of cases).
Aortic valve
calcification
Pathophysiology

11. Streptococcus Pyogenes
Pathophysiology
Rheumatic fever : less than 10% of cases

12. Streptococcus
infection Strep bacterium present M
protein (virulence factor) on
cell surface.
Immune response to
strep antigens
Buildup of fibrotic
connective tissue in valves.
Fibrous thickening/calcification
of valves leaflets fusion of
commissures
Aortic
Stenosis
Inflammatory
response

13. In infants and children:
• Become easily tired
with exertion (in mild
cases)
• Serious breathing
problems that develop
within days or weeks of
birth (in severe cases)
Symptoms

14. Symptoms
Failure to gain weight Poor feeding

15. Symptoms
ASC (Aortic Stenosis Complications)
 The early : Angina
 More seriously : Syncope
 Finally : Congestive Heart Failure
 Sudden Death

16. Symptoms
Angina

17.  Fainting
 Weakness
 Dizziness with exertion activity
Symptoms
Syncope

18. • Breathing problems when
exercising
• Becoming easily tired
• Fatigue
Symptoms
Congestive Heart Failure
(Shortness of Breath)

19. Normal Heart Sound Aortic Stenosis Heart Sound
Signs

20. Signs

22. Pharmacology
 Beta-Adrenergic Receptor Blockers
 Cardiac Glycoside
 Loop Diuretics
 Angiotensin-converting Enzyme (ace) Inhibitor
 Opioid Analgesics

23. Dichloroisoprenaline - first beta blocker Propranolol - first beta blocker
 There are three types of beta receptors :
 Β1 receptors are located in the heart, eye, and kidneys.
 β2 receptors are found in the lungs, gastrointestinal tract, liver, uterus, blood vessels,
and skeletal muscle.
 Β3 receptors are located in fat cells.
Pharmacology
Beta – Adrenergic Receptor Blockers

24. Pharmacology
Beta – Adrenergic Receptor Blockers

25. Pharmacology
Cardiac Glycoside

26. Pharmacology
Loop
Diuretics

27. Pharmacology
Loop
Diuretics

28. Pharmacology
Angiotensin – converting Enzyme (ACE)
Inhibitor

29. PharmacologyPharmacology
Opioid Analgesics

30. Pharmacology
Opioid Analgesics
 Common and short term
 Itch
 Nausea
 Vomiting
 Constipation
 Drowsiness
 Dry mouth
 Other
 Opioid dependence
 Dizziness
 Decreased sex drive
 Impaired sexual function
 Decreased testosterone levels
 Depression
 Immunodeficiency
 Opioid-induced abnormal pain sensitivity
 Irregular menstruation
 Increased risk of falls
 Slowed breathing

31. Pharmacology
Physical Exam

32. Pharmacology
Echocardiogram
Degree of AS
Mean gradient
(mmHg)
Aortic valve area
(cm2)
Mild < 25 > 1.5
Moderate 25 – 40 1.0 – 1.5
Severe > 40 < 1.0
Critical > 70 < 0.6

33. Figure 1.Transesophageal echocardiograms of a normal aortic valve.
(A) Axial view. (B) Horizontal four-chamber view.
Pharmacology
Echocardiogram

34. Figure 2.Transesophageal echocardiograms of severe aortic stenosis.
(A) The axial view shows diffusely thickened leaflets with a restricted opening motion.
(B) The horizontal four-chamber view shows the resultant severe left ventricular hypertrophy and left atrial enlargement.
Pharmacology
Echocardiogram

35. Pharmacology
Other tests for aortic valve stenosis
 ECG
 Chest X-ray
 Cardiac catheterization
 Exercise tests
 Computerized tomography (CT)
 Magnetic resonance imaging (MRI)

36. Monitoring
Hospitalization
Lifestyle patterns
Should stop smoking and be
tested for high cholesterol.
Dental health - Good oral and
dental hygiene
Management

37. Severity of aortic valve
stenosis
How often you should
have an echocardiogram
MILD Every 3 to 5 years
MODERATE Every 1 to 2 years
SEVERE Every 6 to 12 months
Management

38. Management
Balloon valvuloplasty

39. Management
Transcatheter aortic valve replacement

40. Management
Aortic valve replacement

41. Management
Surgical valvuloplasty

42. Discussion