Cardiology: Aortic Valve Disease
Aortic stenosis
- Causes;
- Senile calcification (commonest)
- Congenital – bicuspid valve, William’s syndrome
- Presentation;
- Angina
- Dyspnoea
- Dizziness
- Faints
- Systemic emboli if infective endocarditis
- CCF
- Sudden death
- Signs
- Slow rising pulse with narrow pulse pressure
- Heaving, non-displaced apex beat
- LV heave
- Aortic thrill
- Ejection systolic murmur which radiates to the carotids
- Tests
- ECG – P-mitrale, LVH with strain pattern, LAD, LBBB or complete AV block (calcified rings)
- CXR – LVH, calcified aortic valve, post-stenotic dilation of the ascending aorta
- ECHO – diagnostic, severe stenosis if gradient >50mmHg and valve area <0.5cm
- Differential diagnosis
- Management
- If symptomatic then prognosis is poor – 2-3yr survival if angina/syncope, 1-2yr if cardiac failure
- Prompt valve replacement is recommended if symptomatic or if not symptomatic but with severe AS and deteriorating ECG
Aortic regurgitation
- Causes;
- Congenital
- Rheumatic fever
- IE
- RA, SLE
- Aortic root disease;
- Hypertension
- Trauma
- Aortic dissection
- Seronegative arthropathies – AS, Reiter’s syndrome, psoriatic arthropathy
- Marfan’s syndrome
- Osterogenesis imperfecta
- Syphilitic aortitis
- Symptoms
- Dyspnoea
- Palpitations
- Cardiac failure
- Signs
- Water hammer pulse
- Wide pulse pressure
- Displaced hyperdynamic apex beat
- High pitched early diastolic murmur best heard in expiration with patient sitting forward
- Corrigan’s sign – carotid pulsation
- De Musset’s sign – head nodding
- Quincke’s sign – capillary pulsation in nail beds
- Duroziez’s sign – femoral diastolic murmur as blood flows backward in diastole
- Traube’s sign – pistol shot femorals
- In severe AF an Austin flint murmur may be heard
- Tests
- ECG – LVH
- CXR – cardiomegaly, dilated ascending aorta, pulmonary oedema
- ECHO
- Cardiac catheterisation
- Management
- Indications for surgery
- Increasing symptoms
- Enlarging heart on CXR/Echo
- ECG deterioration (T wave inversion)
- Infective endocarditis refractive to surgery
- Aim to replace the valve before significant dysfunction occurs
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