aortic stenosis

AORTIC STENOSIS

(AS)

Đinh Trần Xuân Trường

Nguyễn Ngọc Tú Quỳnh

Trần Thanh Tuấn

Trần Triển

Ngô Trung

Huỳnh Trọng Ân

Huỳnh An Khang

Đỗ Nhật Minh Trực

Nguyễn Hoàng Phi Yến

Members

1. Anatomy and Physiology

2. Pathophysiology

3. Signs and Symptoms

4. Pharmacology

5. Investigation

6. Management

7. Discussion

Layout

Anatomy and Physiology

The abnormal narrowing of the aortic valve

Anatomy and Physiology

Congenital heart defect : 50% of cases

Aortic valve calcification : 30 -40% of cases

Rheumatic fever : less than 10% of cases

Pathophysiology

Congenital heart defect One leaflet (unicuspid) Two leaflets (bicuspid 27 - 50%) Four leaflets (quadricuspid)

Pathophysiology

Unicuspid

Quadricuspid

Bicuspid

The buildup of calcium deposits narrow the valve(30-40% of cases).

Aortic valve calcification

Pathophysiology

Streptococcus Pyogenes

PathophysiologyRheumatic fever : less than 10% of cases

Streptococcus infection Strep bacterium present M

protein (virulence factor) on cell surface.

Immune response to strep antigens

Buildup of fibrotic connective tissue in valves.

Fibrous thickening/calcification of valves leaflets fusion of

commissures

Aortic Stenosis

Inflammatory response

In infants and children:

• Become easily tiredwith exertion (in mildcases)

• Serious breathingproblems that developwithin days or weeks ofbirth (in severe cases)

Symptoms

SymptomsFailure to gain weight Poor feeding

Symptoms

ASC (Aortic Stenosis Complications)

The early : Angina

More seriously : Syncope

Finally : Congestive Heart Failure

Sudden Death

SymptomsAngina

FaintingWeakness Dizziness with exertion activity

SymptomsSyncope

• Breathing problems when exercising

• Becoming easily tired• Fatigue

Symptoms

Congestive Heart Failure(Shortness of Breath)

Normal Heart Sound Aortic Stenosis Heart Sound

Signs

Pharmacology Beta-Adrenergic Receptor Blockers

Cardiac Glycoside

Loop Diuretics

Angiotensin-converting Enzyme (ace) Inhibitor

Opioid Analgesics

Dichloroisoprenaline - first beta blocker Propranolol - first beta blocker There are three types of beta receptors : Β1 receptors are located in the heart, eye, and kidneys. β2 receptors are found in the lungs, gastrointestinal tract, liver, uterus, blood vessels,

and skeletal muscle. Β3 receptors are located in fat cells.

PharmacologyBeta – Adrenergic Receptor Blockers

PharmacologyBeta – Adrenergic Receptor Blockers

PharmacologyCardiac Glycoside

PharmacologyLoop Diuretics

PharmacologyAngiotensin – converting Enzyme (ACE) Inhibitor

PharmacologyPharmacologyOpioid Analgesics

PharmacologyOpioid Analgesics

Common and short term

Itch

Nausea

Vomiting

Constipation

Drowsiness

Dry mouth

Other

Opioid dependence

Dizziness

Decreased sex drive

Impaired sexual function

Decreased testosterone levels

Depression

Immunodeficiency

Opioid-induced abnormal pain sensitivity

Irregular menstruation

Increased risk of falls

Slowed breathing

PharmacologyPhysical Exam

PharmacologyEchocardiogram

Degree of ASMean gradient

(mmHg)Aortic valve area

(cm2)

Mild < 25 > 1.5

Moderate 25 – 40 1.0 – 1.5

Severe > 40 < 1.0

Critical > 70 < 0.6

Figure 1.Transesophageal echocardiograms of a normal aortic valve.(A) Axial view. (B) Horizontal four-chamber view.


Figure 2.Transesophageal echocardiograms of severe aortic stenosis.(A) The axial view shows diffusely thickened leaflets with a restricted opening motion.

(B) The horizontal four-chamber view shows the resultant severe left ventricular hypertrophy and left atrial enlargement.


PharmacologyOther tests for aortic valve stenosis

ECG

Chest X-ray

Cardiac catheterization

Exercise tests

Computerized tomography (CT)

Magnetic resonance imaging (MRI)

Monitoring

Hospitalization

Lifestyle patterns

Should stop smoking and be

tested for high cholesterol.

Dental health - Good oral and

dental hygiene

Management

Severity of aortic valve stenosis

How often you should have an echocardiogram

MILD Every 3 to 5 years

MODERATE Every 1 to 2 years

SEVERE Every 6 to 12 months

Management

ManagementBalloon valvuloplasty

ManagementTranscatheter aortic valve replacement

ManagementAortic valve replacement

ManagementSurgical valvuloplasty

Discussion

aortic stenosis

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