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Aortic Stenosis

Dr Swapnil Pawar September 28, 2021 28


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    Aortic Stenosis
    Dr Swapnil Pawar

Aortic Stenosis

Blog written by Dr Andrew Lam

Clinical Characteristics of Mitral Regurgitation vs. Aortic Stenosis

Aortic Stenosis Mitral Regurgitation
Character Crescendo-Decrescendo Mid-Systolic Murmur Pan-Systolic Murmur
Radiation To Carotids To Axilla
Location of Greatest Intensity R. Upper Sternal Border 5th Intercostal Space, Mid-Clavicular Line
Variation With Respiration Louder on expiration, softer on inspiration Louder on expiration, softer on inspiration

Grading of Aortic Stenosis 

Stage A (At Risk of Aortic Stenosis) – asymptomatic patients who are at risk of aortic stenosis (i.e. bicuspid aortic valve or aortic sclerosis)

Stage B (Progressive Aortic Stenosis) – asymptomatic patients with mild-moderate disease

Stage C (Asymptomatic Severe Aortic Stenosis) – patients with findings suggestive of severe valve obstruction, but still remain asymptomatic

Stage D (Symptomatic Severe Aortic Stenosis) – Patients with severe valve obstruction but clinically also exhibit symptoms

Complications of Aortic Stenosis

Heart Failure

Left ventricular hypertrophy is common in the context of aortic stenosis. Consequently, patients develop diastolic heart failure, often with preserved ejection fractions. Due to increased diastolic pressures, patients can also develop pulmonary hypertension

Arrhythmias

Patients have an increased risk of ventricular and supraventricular arrhythmias, thought to be secondary to LV hypertrophy

Sudden Cardiac Death

The mechanism is not well established but appears to be reduced following valve replacement. Annual risk for severe asymptomatic AS is 1%, but for those with severe, symptomatic AS, rates range from 8-34%.

Endocarditis

Risk increases particularly in those with congenital abnormalities (i.e. bicuspid aortic valve)

Heyde Syndrome

A syndrome involving gastrointestinal bleeding from angiodysplasia in the context of aortic stenosis. Thought to be due to the high velocity of blood in aortic stenosis resulting in unravelling of von-Willebrand Factor that inhibits its function, and hence, promotes bleeding

References:

Otto, C.M. (2021) Clinical manifestations and diagnosis of aortic stenosis in adults. UpToDate. Retrieved 18th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-aortic-stenosis-in-adults

 

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