Important symptoms of AS are
1.
Exertional
angina
2.
Exertional
syncope
3.
Exertional
dyspnea
What is the
mechanism of dyspnoea in AS.
Dyspnoea
in AS is due to left ventricular dysfunction resulting in elevated pulmonary capillary
pressure.
What is the
mechanism of angina in AS
Angina
occur due to the imbalance between myocardial oxygen supply and demand.
1.
There
is increased myocardial oxygen demand due to left ventricular hypertrophy (LVH).
2.
Decreased
blood supply is due to an increase in left ventricular end diastolic pressure
which decreases the coronary perfusion gradient.
What is the mechanism of syncope in aortic stenosis
Syncope is due to reduction in cerebral blood flow.
Mechanisms are
1.
Systemic
vasodilation against a fixed cardiac output
2.
Transient
atrioventricular arrhythmia
3.
Transient
AV block
4.
Vasodepressor
response due to baroreceptor malfunction
How will you
correlate the development of symptoms with survival in AS
Symptom
|
Duration
of survival
|
Angina
|
5 yrs
|
Syncope
|
3 yrs
|
Dyspnoea
|
2 yrs
|
Cardiac failure
|
1.5yrs
|
Describe the other
presentations of AS
Other
presentations of AS are
-
Cardiac
failure (CCF)
-
Infective
endocarditis (IEC)
-
Sudden
cardiac death - it may be due to complete heart block or atrial tachyarrhythmia
-
Gastrointestinal
bleeding
What is the
mechanism of CVA in AS
1.
Due
to embolism from thrombi in valve
Why gastrointestinal
bleeding occur in AS
Angiodysplasia,
particulary in persons with calcific AS. A pure aortic valve disease may remain asymptomatic for 10-15 years.
