Aortic Stenosis

Block 2.3, KFU, Al-Ahsa, Saudi Arabia

1. Aortic Stenosis
Abdullatiff Sami Al-Rashed
Group 6

2. Objectives
•Definition.
•Etiology.
•Epidemiology.
•Pathophysiology.
•Clinical pictures.
•The Case

3. Aortic Stenosis
•Aortic valve stenosis (AS) is a disease of the
heart valves in which the opening of the aortic
valve is narrowed.
•This narrowing prevents the valve from opening
fully, which obstructs blood flow from the heart
into the aorta and onward to the rest of your
body.

4. Normal Anatomy

6. Etiology
Congenital heart defect:
Normal aortic valves have three leaves (tricuspid), but some
individuals are born with an aortic valve that has two leaves
(bicuspid).
•Calcium buildup on the valve:
In old age, Caused by accumulation of calcium in the valve
•Rheumatic fever:
More in males

8. Epidemiology
Age Percentage
Over 65 2%
Over 75 3%
Over 85 4%
Type Number of cases
congenital Aortic
valve stenosis
Occurs in 3 of
every 1,000 births.
Type Number of Cases
Rheumatic AS Rare
http://www.patient.co.uk/doctor/aortic-stenosis-pro
http://en.wikipedia.org/wiki/Aortic_valve_stenosis#Epidemi
ology

9. Pathophysiology
1.Pressure overload causes obstruction to LV
outflow, which results in left ventricular
hypertrophy (LVH).
2.With long standing as, the left ventricle
dilates, causing progressive lv dysfunction.
3.This end with heart failure due to pressure
overload

11. Clinical Picture
Symptoms:
•Dyspnea on exertion.
•Angina.
•Fainting, weakness, or
dizziness with activity.
•Palpitations.
•Syncope.

12. Clinical Picture
Signs:
•Low pulse pressure.
•Sustained apex.
•Systolic thrill.
•Ejection systolic murmur
•Soft delayed aortic component

13. The Case
•How can these observations be
explained?
Let’s discuss !

14. The Case
•A 85 year old women comes to the outpatient clinic
because of edema. She is tired and she never ad a
full collapse. Her medical history shows no cardiac
disease. Physical examination shows BP of 145/85
mmHg, her pulse is weak with rate of 66 beats per
minute. There is a thrill over the carotid arteries. Her
second heart sound is feeble and a loud systolic
murmur has a maximum at the second intercostal
space right to the sternum. The murmur is almost is
connected to the second heart sound. Physical
examination of her lungs is normal and She has no
edema

15. Important things in the case:
•Dyspnea in rest.
•History of angina.
•Faints, but she never had a full collapse.
•No history of cardiac diseases.
•BP: 145/85 … Hypertensive.
•Weak pulse… 66 beats per min.
•Thrill over carotid artery.
•2
nd
heart sound is feeble.
•Loud systolic murmur.
•No edema

16. References
•http://www.nlm.nih.gov/medlineplus/ency/a
rticle/000178.htm
•http://www.mayoclinic.org/diseases-
conditions/aortic-
stenosis/basics/definition/con-20026329