Aortic Valve Disease

• What is aortic stenosis (AS) characterized by?


  Narrowing of the aortic valve
• What does aortic stenosis restrict?


  Blood flow from the left ventricle to the aorta
• What is the estimated prevalence of severe aortic stenosis in those over 75 years old?


  3%
• What are some causes of aortic stenosis?


  Senile calcification, congenital bicuspid valve, rheumatic heart disease, supravalvular stenosis
• What symptoms may present in severe cases of aortic stenosis?


  Syncope, angina, and dyspnoea
• How is aortic stenosis diagnosed?


  Through echocardiography
• What is the management approach for asymptomatic aortic stenosis?


  Conservative management with regular echocardiograms
• What is required for symptomatic aortic stenosis?


  Medical treatment to optimize symptoms and consideration for surgical interventions
• What is the risk associated with severe, symptomatic aortic stenosis without intervention?


  High risk of mortality
• What does aortic stenosis refer to?


  Narrowing and tightening of the aortic valve
• What is the prevalence of severe aortic stenosis in individuals over 75 years old?


  3%
• What happens to the left ventricle in aortic stenosis?


  It has to generate more pressure to pump blood
• What is the initial response of the left ventricle to aortic stenosis?


  Left ventricular hypertrophy
• What occurs over time if the left ventricle can no longer compensate in aortic stenosis?


  The left ventricle enlarges and cardiac output reduces
• What are the causes of aortic stenosis?


  • Senile calcification (most common in those >65 years)
  • Congenital bicuspid valve (most common in those <65 years)
  • Rheumatic heart disease
  • William's syndrome (supravalvular stenosis)
• What mnemonic can help remember the symptoms of severe aortic stenosis?


  'SAD' for syncope, angina, dyspnoea
• What are some other symptoms of severe aortic stenosis?


  Pre-syncope, palpitations, left ventricular heart failure symptoms
• What are some signs of aortic stenosis?


  Slow-rising carotid pulse, narrow pulse pressure, ejection systolic murmur
• Where is the ejection systolic murmur best heard in aortic stenosis?


  At the second intercostal space on the right
• What does a soft S2 heart sound indicate in aortic stenosis?


  It corresponds with severity
• What does the ECG show in aortic stenosis?


  Left ventricular hypertrophy, left axis deviation, poor R wave progression
• What does a chest X-ray reveal in aortic stenosis?


  Cardiomegaly and evidence of pulmonary oedema
• What is the definitive diagnosis for aortic stenosis?


  Echocardiogram
• What parameters classify severe aortic stenosis?


  Peak gradient > 40 mmHg, valve area < 1.0 cm², aortic jet velocity > 4 m/s
• What is the purpose of exercise testing in aortic stenosis?


  To assess the true severity of asymptomatic patients
• What additional information can cardiac MRI provide in aortic stenosis?


  Valve morphology, dimensions of the aortic root, and extent of valve calcification
• What is the management approach for aortic stenosis?


  • Conservative management for asymptomatic cases
  • Regular echocardiograms: severe AS every 6 months, mild-to-moderate AS yearly
  • Medical management for symptomatic AS
  • Surgical intervention for symptomatic patients and specific asymptomatic cases
• What is the role of medical management in aortic stenosis?


  Symptom management of left ventricular failure
• When is surgical intervention indicated in aortic stenosis?


  In symptomatic patients and specific asymptomatic cases
• What are the choices of intervention for aortic stenosis?

  Transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR)
• In which patients is TAVI favored?


  Patients with severe comorbidities, previous heart surgery, frailty, and those older than 75 years
• In which patients is SAVR favored?


  Patients who are low risk and less than 75 years of age
• What can untreated aortic stenosis lead to?


  Left ventricular failure and sudden cardiac death
• What is the prognosis for severe, symptomatic aortic stenosis?


  High risk of sudden death with a mortality rate of 50% at 1 year
• What is aortic sclerosis?


  An asymptomatic condition caused by age-related degeneration of the valve
• What are the classic findings of aortic sclerosis?


  An ejection systolic murmur that does not radiate to the carotids
• How is aortic regurgitation defined?


  When the aortic valve fails to prevent blood from flowing back into the left ventricle during diastole
• What are the two classifications of aortic regurgitation?


  Acute and chronic
• What are some causes of acute aortic regurgitation?

  Infective endocarditis, aortic dissection, traumatic rupture of valve leaflets
• What are some causes of chronic aortic regurgitation?


  Rheumatic heart disease, age-related calcification, congenital bicuspid aortic valve