Aortic Stenosis

Record :

I would end my exmination by checking the BP for narrow pulse pressure, fundoscopy for Roth spot, abd for splenomegaly, urinalysis for proteinuria and haematuria, all peripheral pulses.

This lady has a PR of 95/min, regular, slow rising, no radio-radial delay and no collapsing pulse. There is no clubbing or stigmata of infective endocarditis. There is no pallor, jaundice or cyanosis. JVP is not elevated. There is no pedal edema of the legs. There is a right mastectomy scar. The apex beat is not displaced, L 5th ICS at MCL, heaving in character. There is no parasternal heave or thrill felt. Normal 1st and 2nd HS. There is a Grade 3 ESM at the aortic radiating to the neck. Lungs - clear

My diagnosis is that this lady has aortic stenosis most likely due to CRHD with no evidence of PH, IE or cardiac failure.

eMRCPian : What other possible aetiology ?
Ans : Degenerative valve or Bicuspid valve

eMRCPian : What are the signs of severe AS ?
Ans : Narrow pulse pressure, Soft S2, Narrow split S2, S4, systolic thrill and heaving apex beat, cardiac failure

eMRCPian : How would you investgate this pt ?
Ans :
CXR - cardiac enlargement, calcification of valve
ECG - LVH, LAD
Echo - confirm dx, assess severity, assess LV function

eMRCPian : How do u MX this pt ?
Ans :
Divide into symptomatic and asymptomatic
Symptomatic - AV replacement
Asymptomatic - follow up pt, assess severity

AVR for asymptomatic - valvular gradient > 50 mmHg, valve area < 0.6 cm2

Score : 3/3