A.S
A) Org Causes
1. Valvular
*Rh. child *Cong. Child *Calcific old age, isolated
history isolated young (calcific
M.V.D. other cong. Bicuspid valve)
(Usually associated) anomalies
2. Subvalvular A.S e., HocM.
3. Supravalvular A.S Elfin facies, Mental R usually associated
(william’s syndrome).
B) Functional causes
In severe AI – hperdynamic ciculation

Haemodynamics
A.S. Pr.L. on left V left V. + + ischaemia heart failure
C/P
Triad
¯ cop

Chest pain
¯ cop
Due to Lt. V. + +
Lt. V. F.


*
¯ COP(syncope)

exertional At rest

occur in in calcific type
any A.S
calcification in conductive system (AVB)

heart. block

* Chest pain


A.S associated coronary atherosclerosis
Itself esp with calcific type (old age)
¯
COP Lf. V hypertrophy

O/E
Pulse platuae (small volume and is slow-rising)
* Insp. & palp:
Lt. V. + + , apex sustained and localized

Due Concentric hypertrophy

i.e. Lt. V. + + , apex at 5th space (diagnosed by ECG and
echo) late,
dilatation apex shifted
* Thrill (base neck) = Org. A.S
A1
murmur A2 Allover loud
neck harsh
apex

S1 (Lt. V. + +) muscle. Component of S1
S 2 Aortic Pr. S2
S3 Lt. V. failure (late) (S3 Apex)
S4 A.S. Lt. V. pr. Vigorous atcial
contraction (S4 apex)

Investigation
E.C.G., X-ray Lt. V. + + with strain in severe cases
Catheter: to measure pr. Gradient across Aortic valve.
Pr. Gradient > 50 mm. Hg
= severe A.S.
Echo * valve area < 0.7 cm2
* Normally 2.5 cm2
* Also it can measure pressure gradient across Aortic valve
Treatment

(No role for medical ttt, digit & diuretics may sympt)
Surgery V.R.
Indications (sympt + pr. Gr > 50).
Valvotomy (sympt + pr. Gr > 50).
Aortic balloon valvoplasty transient improvement.
Mild A-S follow up with echo to detect the progression of stenosis.
Angina best treated with BB, vasodilators or nitrates are better avoided as they aggravate exertional syncope

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)