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Pathology
Narrowed aortic valve orifice leading to LV pressure overload and causing Left Ventricular Hypertrophy, Left Ventricular Failure, pulmonary oedema and Chronic Heart Failure
Aetiology
Congenital: bicuspid valve causing calcified degeneration or congenital AS
Acquired: degenerative calcified AS (most common), “wear and tear”, rheumatic heart disease
Signs
Pulse: narrow pulse pressure, brachial radial delay, slow rising pulse
Chest: heaving, displaced apex beat, ejection systolic murmur radiating to
carotids and heard loudest over aortic valve area Soft S2 with splitting of
S2 in severe disease, 4th heart sound
Symptoms
Exertional angina, dyspnoea, syncope, signs & symptoms of CHF if severe (pulmonary oedema, congestive hepatomegaly)
Investigations
ECG: Left Ventricular Hypertrophy, LBBB, Left Atrial Enlargement, AF
Chest X-Ray: Post-stenotic aortic root dilatation, calcified valve, Left Ventricular
Hypertrophy + Left Atrial Enlargement, Chronic Heart Failure
Echo: Assess severity by looking at Valvular area and pressure gradient, Left
Ventricular Hypertrophy and LV function
Cardiac catheterisation: exclude CAD or inconclusive ECHO
Treatment
Medical: Symptom control – Diuretics, Beta-blockers
Surgical: Aortic valve replacement
Prognosis
Untreated, symptomatic patients have high mortality rate
Ventricular dysrhythmias, sudden death, heart block, prosthetic valve failure
Key Facts
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Key Images
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Key References
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