This narrowing of the aortic valve is now the commonest form of valvular disease presenting in the west.
Symptoms: Triad of Angina, Breathlessness and Syncope
Signs:
- Slow rising pulse (best felt using four fingers across the pulse)
- Palpable heaving apex (LVH)
- Ejection Systolic Murmur, often radiating to the carotids and best heard in the aortic region.
Severe Signs:
- Soft or loss of second HS
- Low volume slow rising pulse
- Reversed splitting of S2
Causes
Common:
- Calcific Degeneration (commonest)
- Congenital bicuspid valve
Rare:
- Post Rheumatic fever (rare)
- Congenital
- Infective Endocarditis
- Hyperuricaemia
- Pagets disease
Investigations
Bedside: ECG: Looking for LVH, Arrhythmias and Heart block (calcific degenerative cause can also cause calcium deposits in the AVN and thus AV block)
Bloods: FBC/U&E
Functional: Echocardiogram
Imaging: N/A
Invasive: Angiogram: if patient requires Aortic valve replacement then assessment for necessity of a CABG should be done via an angiogram.
Management
Be careful to avoid medications that decrease after-load in patients with severe AS (ACEi, vasodilators including GTN), as this could drastically decrease blood pressure if the LVOT obstruction is severe.
Indications for valve replacement:
- Symptomatic patient with PPD >50mmHg
- Asymptomatic patient: Moderate or severe AS undergoing a CABG OR Severe AS with LVSD, abnormal BP response to exercise on exercise tolerance test, episodes of VT or valve area <0.6cm2.
Options for replacement are via percutaneous options (TAVI) or open heart surgery for Metallic of tissue valve replacement.
Different valve replacements will be discussed later in the prosthetic valve section.
Written by Dr Thomas Craven
Resources used to write this document are listed in the references section of this webpage