Commonest Cause - Calcified Bicuspid Valve, More Common in Men

Aortic Stenosis

commonest cause - calcified bicuspid valve, more common in men

Younger patients - congenital or rheumatic fever

Older women - senile degenerative calcification

Progresses gradually, causing left ventricular outflow obstruction and hypertrophy

Late complications: ventricular dilatation, Heart failure

Symptoms

Initially asymptomatic

Late - angina pectoris

exertional dyspnoea

syncope

sudden death - ventricular dysrhythmias

Signs

Plateau pulse - small volume, slow rising

Low pulse pressure

Apex beat - forceful sustained heave (due to LVH)

Systolic thrill with radiation to carotid arteries

HARSH EJECTION SYSTOLIC MURMUR

Soft S1,

Soft 2nd aortic sound

Reversed splitting

S4 - atrial gallop

Murmur becomes quieter as the heart fails and signs of LVF become apparent

INVESTIGATIONS

ECG - LVH, increased QRS, ST/T segment changes

CXR - Normal heart size

Ascending aorta may be prominent due to post stenotic dilatation

Valve may be calcified

Echocardiography - calcified valve

+ Doppler studies: valve area, pressure gradient, cardiac chamber dimensions

Catheterisation - exclude co-existing coronary disease

-  systolic gradient

MANAGEMENT

Sever stenosis - valve replacement

Drugs do not alter progression

- diuretics and digoxin for heart failure