Aortic stenosis部分知识点

岛民A

Cause

<70 yo

Bicuspid aortic valve

>70 yo

Senile calcific aortic stenosis  

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Symptoms

Incomplete lv emptying → pulmonary venous congestion → exacerbation of dyspnea.

Dyspnea: early sign of HF, which occurs insevere AS

Dyspnea is the most significant predictorof poor prognosis in AS, with syncope and angina pectoris following.

About 50% of AS patients who experiencedyspnea die within 2 yo of symptom onset. Aortic valve replacement can helpslow the rapid ↓ in life expectancy after symptoms begin.

Peripheral vasodilation during exercise →Severe AS obstructs blood flow → Inability to increase CO → Decreased BP →Reduced cerebral blood flow → Syncope, dizziness, dyspnea, and angina pectoris

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Pts who have asymptomatic severe ASshould be closely monitored for the emergence of any new symptoms. For theseindividuals, it is recommended to perform follow-up echocardiograms every 6 to12 months to assess changes in LV function over time.

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Supravalvular aortic stenosis

-systolic murmur

-best heard at the 1st R intercostalspace

- may also have unequal carotid pulses, differential blood pressure inthe upper extremities (high pressure jet in ascending aorta), and a palpable thrillin the suprasternal notch.

↑myocardial oxygen demand during exercisecan cause subendocardial or myocardial ischemia, likely triggering thepatient's exercise-induced anginal symptoms.

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Symptomatic aortic stenosis

-Cardiovascular contraindications topregnancy

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severe AS

Postpulmonary obstructive shock

high CVP, high PCWP, and low co

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aortic stenosis can cause Heart failurewith preserved LVEF (or diastolic dysfunction)

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aortic stenosis

-R 2nd intercostal murmur(or at cardiac base)

- Mildto moderate AS : early peaking murmur

- Severe AS : longer latesystolic murmur.

- While most murmurs with anintensity of grade 3 or higher are pathological

-intensity does not always correlate with severity

-The murmur in severe AS decreasesin intensity and may even disappear once the patient develops left heartfailure.

- delayed pulses (pulsus parvus et tardus),weak peripheral pulses

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aortic stenosis can ↑bleeding from Angiodysplasia

Angiodysplasia ：abnormally dilated blood vessels in the intestines, mc ly found in the rightcolon. It often presents with melena, painless lowrectal bleeding, and/or iron deficiency anemia. This conditionprimarily affects individuals > 60.

The risk of bleeding from angiodysplasiasis higher in patients with end-stage renal disease, vonWillebrand disease (VWD), and aortic stenosis (AS).

Aortic stenosis is believed to increasebleeding risk due to the destruction of circulating von Willebrand factor.

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Dihydropyridine ccbs (such as amlodipine)are generally contraindicated in patients with severe AS. These drugs causevasodilation, which can lower PVR, making it harder for the LV to pump bloodthrough the narrowed valve. This can worsen the heart's workload, lead tohypotension, and impair cardiac perfusion, especially in already compromisedheart structures. Therefore, these medications should be avoided or used withcaution in such patients.

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TAVR is for pts with AS who exhibit symptoms or have a LVEF below 50%.

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