Aortic stenosis

• What does aortic stenosis refer to?

  Obstruction of blood flow across the aortic valve
• What is the most common valvular disease in Europe and North America?

  Aortic stenosis
• What percentage of those over 65 are affected by aortic stenosis?

  2-7%
• How much more frequently does symptomatic aortic stenosis affect men compared to women?

  Four times more frequently
• In which decades of life does aortic stenosis typically present?

  Seventh or eighth decades
• What is the most common cause of aortic stenosis in the western world?

  Calcification
• What is the degenerative condition that causes calcific aortic stenosis?

  Inflammation and progressive calcification
• What are the risk factors for calcific aortic stenosis?

  Hypercholesterolaemia, hypertension, smoking, diabetes
• What is the frequency of bicuspid valve occurrence as a congenital abnormality?

  1-2%
• At what age does stenosis typically appear in patients with a bicuspid valve?

  Under 65 years
• What autoimmune condition can lead to aortic stenosis?

  Rheumatic heart disease
• What causes inflammation in rheumatic heart disease?

  Molecular mimicry following streptococcal infection
• What tissues are affected by rheumatic heart disease?

  Heart, joints, CNS
• What happens to the left ventricle in aortic stenosis?

  It undergoes hypertrophy
• What type of murmur may be heard due to aortic stenosis?

  Ejection systolic murmur
• What does a pressure gradient across the aortic valve indicate?

  Aortic stenosis severity
• What compensatory mechanism occurs in response to aortic stenosis?

  Left ventricular concentric hypertrophy
• What are the features of left-sided heart failure due to aortic stenosis?

  Shortness of breath and bibasal crackles
• What can lead to exertional syncope in aortic stenosis patients?

  Exhaustion of compensatory mechanisms
• What causes angina in aortic stenosis patients?

  Reduced coronary flow and increased oxygen requirements
• What is the classical triad of symptoms in aortic stenosis?

  Syncope, angina, dyspnoea
• In what percentage of patients is the classical triad seen?

  40-50%
• What condition can arise from turbulent flow across the stenotic aortic valve?

  Acquired von Willebrand deficiency
• What sign indicates severity in aortic stenosis?

  Soft S2
• What does a fourth heart sound (S4) indicate?

  Atria contracting against stiff ventricles
• What is the primary investigation used to diagnose aortic stenosis?

  Echocardiogram
• What does a chest X-ray typically show in aortic stenosis?

  Small heart (cardiomegaly if heart failure develops) and dilated ascending aorta
• How is aortic stenosis classified by severity?

  Transaortic pressure gradient and valve area
• What may be indicated by a positive ECG exercise stress test?

  Onset of symptoms or abnormal BP response
• When is surgical aortic valve replacement indicated?

  In severe or symptomatic disease
• What is the purpose of valvotomy in aortic stenosis treatment?

  To force apart stenotic valve leaflets
• What are the two types of valve replacement options?

  Mechanical valve and bioprosthetic valve
• What is a key consideration for choosing between mechanical and bioprosthetic valves?

  Patient-specific factors and wishes
• What is transcatheter aortic valve replacement (TAVR)?

  A minimally invasive valve replacement technique
• What may a coronary angiogram demonstrate in aortic stenosis patients?

  Atherosclerotic disease for CABG treatment