Aortic Stenosis
Also written as AS.
VSD, ASD and AV canal defects are acyanotic unless the shunt reverses (Eisenmenger), and aortic stenosis is acyanotic too, so the question is loosely worded.
Aortic Stenosis
- Most common valvular disease in developed world (in elderly)
- Causes: Age-related calcification ( 1 in elderly), bicuspid aortic valve ( 1 in young), rheumatic fever
- Classic triad: SAD — Syncope, Angina, Dyspnea
- Harsh systolic ejection murmur at right upper sternal border radiating to carotids
- Prognosis: 2–3 years after symptom onset without treatment
Read this in Comprehensive Heart Pathology Notes 🫀
What our notes say
- VSD, ASD and AV canal defects are acyanotic unless the shunt reverses (Eisenmenger), and aortic stenosis is acyanotic too, so the question is loosely worded. (Paediatrics end of second semester exam (MBPE 4300): 4 October 2022, cardiology,)
- Angina, syncope and heart failure are the classic triad of symptomatic aortic stenosis, with a slow-rising pulse, narrow pulse pressure and a murmur radiating to the carotids. (Cardiology Question Bank: 15 Clinical MCQs)
- | Aortic stenosis | Ejection systolic, right 2nd intercostal space | Radiates to the carotids; slow-rising pulse | (Heart murmurs)
- Other causes: degenerative calcific aortic stenosis (older patients), a bicuspid aortic valve, infective endocarditis, mitral valve prolapse, and ischaemia (papillary muscle rupture after a heart attack). (Heart murmurs)
- 3) Heaving – a vigorous and sustained pulsation due to pressure overload aortic stenosis/systemic hypertension. (Cardiovascular system examination revised 2012 — Past Paper Questions & Answers)
- 1) Aortic stenosis (2nd intercostal space on the spreading upwards towards the neck). (Cardiovascular system examination revised 2012 — Past Paper Questions & Answers)
Study material on Aortic Stenosis
- 🫀 VALVULAR HEART DISEASE — ULTRA DEEP NOTES
- Cardiovascular system examination revised 2012
- Heart murmurs
- CVS History, Physical Exam & ECG: Master Clinical Assessment
- CVS History & Physical Exam: Symptoms, Chest Pain & Syncope
- Paediatrics end of second semester exam (MBPE 4300): 4 October 2022, cardiology, hepatology and gastroenterology, 47 of 50 MCQs
- CARDIOVASCULAR PATHOLOGY
- Cranial Nerves, Eye Exam & Vital Signs: MBChB Clinical Revision
- High-Yield Clinical Exam Notes: Cranial Nerves, Respiratory, Cardio
Practice questions on Aortic Stenosis
A 65-year-old man with aortic stenosis develops left ventricular hypertrophy. This adaptation will eventually fail primarily because:
- Myocytes reach maximum size and cannot enlarge further
- Blood supply cannot keep pace with increased metabolic demands
- Sarcomeres become disorganized with further stress
- Apoptosis of myocytes increases progressively
Answer: B. Cardiac hypertrophy increases metabolic demands of the enlarged myocytes. When blood supply cannot match these demands (relative ischemia), the adaptation fails and progresses to heart failure. While apoptosis may occur later and sarcomere disorganization happens, the primary reason for failure is inadequate perfusion of the hypertrophied muscle mass creating an energy deficit. ---