Aortic StenosisAbdullatiff Sami Al-Rashed

Group 6

Objectives

• Definition.

• Etiology.

• Epidemiology.

• Pathophysiology.

• Clinical pictures.

• The Case

Aortic Stenosis

• Aortic valve stenosis (AS) is a disease of the heart valves in which the opening of the aortic valve is narrowed.

• This narrowing prevents the valve from opening fully, which obstructs blood flow from the heart into the aorta and onward to the rest of your body.

Normal Anatomy

Etiology

Congenital heart defect: Normal aortic valves have three leaves (tricuspid), but some

individuals are born with an aortic valve that has two leaves (bicuspid).

• Calcium buildup on the valve: In old age, Caused by accumulation of calcium in the valve

• Rheumatic fever: More in males

Epidemiology

Age Percentage

Over 65 2%

Over 75 3%

Over 85 4%

Type Number of cases

congenital Aortic valve stenosis

Occurs in 3 of every 1,000 births.

Type Number of Cases

Rheumatic AS Rare

http://www.patient.co.uk/doctor/aortic-stenosis-pro http://en.wikipedia.org/wiki/Aortic_valve_stenosis#Epidemiology

Pathophysiology

1. Pressure overload causes obstruction to LV outflow, which results in left ventricular hypertrophy (LVH).

2. With long standing as, the left ventricle dilates, causing progressive lv dysfunction.

3. This end with heart failure due to pressure overload

Clinical Picture

Symptoms:

• Dyspnea on exertion.

• Angina.

• Fainting, weakness, or dizziness with activity.

• Palpitations.

• Syncope.

Clinical Picture

Signs:

• Low pulse pressure.

• Sustained apex.

• Systolic thrill.

• Ejection systolic murmur

• Soft delayed aortic component

The Case

• How can these observations be explained?

Let’s discuss !

The Case

• A 85 year old women comes to the outpatient clinic because of edema. She is tired and she never ad a full collapse. Her medical history shows no cardiac disease. Physical examination shows BP of 145/85 mmHg, her pulse is weak with rate of 66 beats per minute. There is a thrill over the carotid arteries. Her second heart sound is feeble and a loud systolic murmur has a maximum at the second intercostal space right to the sternum. The murmur is almost is connected to the second heart sound. Physical examination of her lungs is normal and She has no edema

Important things in the case:

• Dyspnea in rest.• History of angina.• Faints, but she never had a full collapse.• No history of cardiac diseases.• BP: 145/85 … Hypertensive.• Weak pulse… 66 beats per min.• Thrill over carotid artery.• 2nd heart sound is feeble.• Loud systolic murmur.• No edema

References

• http://www.nlm.nih.gov/medlineplus/ency/article/000178.htm

• http://www.mayoclinic.org/diseases-conditions/aortic-stenosis/basics/definition/con-20026329