Wednesday, 22 September 2010

MRCP revision battle 18.5: Aortic stenosis

Aortic stenosis may be detected incidentally (keen houseofficer noticing the classical ejection systolic murmur radiating to the carotids) or may present with its classical triad of symptoms that can be remembered as 'DAD':
  • exertional dyspnoea
  • etertional angina
  • exertional dizziness

Signs of aortic stenosis include:
  • ejection systolic murmur radiating to carotids
  • slow rising pulse
  • narrow pulse pressure
  • heaving apex beat

Things which suggest severe aortic stenosis include:
  • LVF
  • soft S2
  • paradoxically split A2
  • S4

 The formal divisions of severity are as follows:
  • mild: area >1.5cm, gradient <25
  • moderate: area 1-1.5cm, gradient 25-50
  • severe: area <1cm, gradient >50
  • critical: area <0.7cm, gradient >80

The main causes of aortic stenosis are:
  • calcification of the valve
  • bicuspid aortic valve

ECG changes which may be associated with aortic stenosis include:
  • p mitrale
  • LVH
  • LAD
  • poor R wave progression
  • complete heart block if calcification involves the conduction tissue.

Treatment is surgical.  The operative mortality is around 20-25% if there is LVF, 2-8% if not.

So from the very factual aortic stenosis on to the slightly touchy-feeling PMR...