12/11/2021
AORTIC STENOSIS:-
occurs when the heart's aortic valve narrows. The valve doesn't open fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and to the rest of your body.
1. Turbulence or murmur when left ventricle ejects blood into aorta
2. 80 ml of blood exits (normal)
3. In aortic stenosis it will take extra time
4. Aortic valve does not close on time thus delayed closure
5. NARROW SPLIT S, A, P.
6. Management of calcified stenosed aortic valve AORTIC VALVE REPLACEMENT (AVR)
If not managed
- condition progress
- more narrow
- more delayed closing
- Gap is progressively reduced
⬇️ further progression
Aortic and pulmonary valve start closing at the same time
- K/as SINGLE S,
- Aortic valve closes after pulmonary valve closure P2,A2= Reverse splitting S2.
A2, P2 (Paradoxical splitting S2,)
- Valvular Aortic stenosis in infant Cause is Bicuspid aortic valve
- In child, caused is Rheumatic heart disease
- In adult, > 65 years cause is senile calcification
- Bimodal distribution
C/F :-
1. Syncope on exertion (⬆️ cardiac output)
2. Angina (obstruction ➡️ left ventricular hypertrophy➡️ Oxygen demand increase
- Mismatch b/w demand and supply (demand increase, supply is normal)
- Subendocardial ischemia
3. Dyspnea ( increase left ventricular filling pressure , pulmonary edema diastolic malfunction)
O/E:-
- In carotid artery,
- Pulse tends to peak in the middle of systole then pressure tends to ease off
- Dicrotic notch, then a fall
- Dicrotic notch present right after the S2
- Peak of pressure generated in the middle of systole (normal)
- In valvular aortic stenosis, outlet obstruction pressure takes time to rise
- Peak of pular delayed, smaller dicrotic notch
- Slow rising pulse (PULSUS TARDUS et PARVUS)
- Amplitude is decrease , dicrotic notch may be absent (anacrotic pulse)
- Double apical impulse, heart negatively bigger apex beat : 5th, 6th intercostal space
- Heaving apex beat (forceful)
- S2: narrow split / single / paradoxical split
- Left ventricular hypertrophy, left atrial hypertrophy (LAH)
- LAH : Atrial kick : S4.
- On auscultation, murmur is heard Increase and decrease of spike, intensity not constant (⬆️ /⬇️ ): EJECTION SYSTOLIC MURMUR
- Aka crescendo-decrescendo murmur
BEST DIAGNOSIS :-
- Echocardiography.