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Aortic stenosis is mainly a disease of this group of people, and its prevalence climbs steeply with each decade.
Older adults. It rises sharply after about age 65.
Where is the aortic valve located, and what is its structure?
Semilunar valve located between the LV and ascending aorta - 3 cusps
What type of ventricular hypertrophy is classically caused by aortic stenosis?
Concentric LVH
What is the initial management of asymptomatic aortic stenosis w/ preserved left ventricular ejection fraction?
Regular clinical checkups, ecg, and management of CVD risk factors
What is the most common cause of aortic stenosis in older adults, and what happens to the valve?
Age-related calcification causes the aortic valve leaflets to stiffen and narrow, obstructing blood flow from the left ventricle into the aorta.
Among people aged 75 and over, roughly this share have severe aortic stenosis.
About 3–4%.
What are the three main arteries that branch off the aortic arch, and what do they supply?
1. Brachiocephalic trunk (Into right subclav a. and right cc a.)
2. Left common carotid a.
3. Left subclavian a.
How does calcification of the aortic valve lead to stenosis?
Calcification stiffens the valve cusps and restricts their opening, reducing the effective valve orifice area.
What is the treatment for severe aortic stenosis?
Aortic valve replacement (SAVR or TAVR)
Name three classic symptoms of aortic stenosis and explain why they occur.
Angina (increased myocardial oxygen demand and reduced coronary perfusion), syncope (reduced ability to increase cardiac output during exertion) and dyspnoea (raised left ventricular filling pressures cause pulmonary congestion).
The most common cause of AS in high-income countries differs from the most common cause worldwide. Name both.
High-income countries: age-related calcific AS
Worldwide (low- and middle-income countries): rheumatic heart disease
Embryological duct connecting the pulmonary artery and descending aorta.
Name this structure -> before and after birth + 1 important nerve surrounding it that hooks under aortic arch?
1. Ductus arteriosus
2. Ligamentum arteriosum
3. Left reccurrent laryngeal nerve (branch of vagus n.)
A patient with aortic stenosis develops angina despite having normal coronary arteries. Explain why.
Elevated LV pressure and reduced coronary perfusion impair myocardial oxygen supply.
LV hypertrophy increases myocardial oxygen demand -> so supply is insufficient relative to demand
Would statins be appropriate treatment for this in a patient with normal cholesterol levels?
NO!!!!! calcification of aortic valve is different from atherosclerosis, and cannot be reversed
yippie!
This congenital valve variant is present in about 1–2% of people, is 2–3 times more common in males, and causes AS decades earlier.
Bicuspid aortic valve.
Name the cusps of the aortic valve, specific name for the aortic sinuses and what arteries come from the these sinuses?
LCC, RCC, NCC
Sinuses of Valsalva
Left and right coronary arteries
Explain how severe aortic stenosis can eventually progress from compensated hypertrophy to left-sided heart failure.
Chronic pressure overload causes LV hypertrophy, fibrosis and reduced compliance (diastolic failure)
Elevated filling pressures cause pulmonary congestion; eventual myocardial dysfunction can reduce contractility and cardiac output.
In a 32yo w/ no symptoms, LVEF <50% what treatment would you give?
Surgical Aortic Valve Replacement
A 25-year-old develops aortic stenosis. What underlying congenital abnormality could explain this, and how does it predispose them to stenosis?
A bicuspid aortic valve, which has two leaflets instead of three.
Abnormal valve structure and turbulent flow increase mechanical stress, promoting earlier calcification and progressive narrowing.