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7 Cards in this Set
- Front
- Back
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etiologies of aortic stenosis (AS) |
calcific: predominant cause in >70y, risk factors incl HTN, high cholesterol, ESRD
congenital: i.e. bicuspid valve w/ premature calcification (cause in 50% of AS <70y)
rheumatic heart disease (AS usually + AI and MV dz) |
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"mimickers" of AS |
subvalvular (e.g. hypertrophic CM, subaortic membrane) or supravalvular stenosis |
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clinical manifestations of AS |
angina (incr O2 requirement 2/2 hypertrophy + decr O2 supply 2/2 decr coronary perfusion, +/- CAD)
syncope, exertional (cannot increase CO when needed)
heart failure (outflow obstr + diastolic dysfxn = pulm edema, worsened with tachycardia and AF) |
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hematologic complication of severe AS? |
acquired vWF disease (~20% of severe AS): destruction of vWF + GI angiodysplasia/bleeding (Heyde's syndrome) |
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murmur of AS |
midsystolic, crescendo-decrescendo murmur at RUSB
harsh, high pitch; radiates to carotids, apex (holo-systolic = Gallavardin effect) |
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how does the murmur of AS change with passive leg raise, standing, and Valsalva? |
increased with passive leg raise, decreased with standing and Valsalva
this is in contrast to the dynamic outflow obstruction of HCM, which decreases with leg raise and increases with standing, Valsalva |
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physical exam signs of severe AS |
late-peaking murmur, paradoxically split S2 or inaudible A2, small and delayed carotid pulse (parvus et tardus), LV heave, +S4 (occ palpable) |
