Aortic stenosis ppt
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Log in. If your hospital, university, trust or other institution provides access to BMJ Best Practice through services such as OpenAthens or Shibboleth, log in via this button: Access through your institution. Sign up for a FREE trial. I have some feedback on:. Submit Feedback.This online textbook has been comprehensively reviewed for the November update. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct.
Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations.
The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. The diagnosis of severe aortic stenosis requires consideration of AVA together with flow rate, pressure gradients the most robust measurementventricular function, size p.
The assessment of the severity of aortic stenosis in patients with low gradient and preserved ejection fraction remains particularly challenging. The strongest indication for intervention remain symptoms of aortic stenosis spontaneous or on exercise testing. The presence of predictors of rapid symptom development can justify early surgery in asymptomatic patients, particularly when surgical risk is low. Although current data favour TAVI in elderly patients who are at increased risk for surgery, particularly when a transfemoral access is possible, the decision between TAVI and SAVR should be made by the Heart Team after careful, comprehensive evaluation of the patient, weighing individually risk and benefit.
Aortic stenosis AS is now the most common valve disease requiring intervention in Europe and North America 12 and it is increasing in prevalence due to the ageing population. AS is most often due to calcification of a normal tricuspid valve or a congenitally bicuspid valve see Chapter The frequency of AS observed on bicuspid valves is higher in patients aged less than 60, and then the trend is inverted afterwards. Calcification begins at the base of the cusps and progresses towards the edges, while the commissures remain open Figure In young adults, congenital aortic stenosis predominates.
Figure Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation ;—5. The association with traditional atherogenic cardiovascular risk factors such as hypertension, current smoking, diabetes, cholesterol levels, and histopathological parallels have led to the hypothesis that AS is primarily an atherosclerotic-like process.
Identification of familial clusters and recent findings implicating genetic polymorphisms of the vitamin D receptor and mutations such as in the NOTCH1 gene 1112 in bicuspid aortic valves suggest that genetic factors may also influence valve pathogenesis. In athe histology of the early lesion is characterized by a subendothelial accumulation of oxidized low-density lipoprotein LDLproduction of angiotensin Ang II, and inflammation with T lymphocytes and macrophages.
The corresponding changes in aortic valve anatomy are viewed from the aortic side with the valve open in systole b and in Doppler aortic-jet velocity c.
Adapted with permission from Otto CM. Calcific aortic stenosis—time to look more closely at the valve. N Engl J Med ;—8. In addition, in patients with bicuspid valves, tissue abnormality is not only localized to aortic cusps but also to the wall of the ascending aorta leading to the development of aortic root and ascending aortic aneurysms.
Normal aortic valve area is 3—4 cm 214 A gradient at rest between the left ventricle LV and aorta begins to appear once the valve area is less than 1. AS is considered severe when the area is less than 1 cm 2 or, more accurately, 0. The obstruction develops gradually. Bicuspid valves are less efficient than tricuspid valves at distributing mechanical stress, leading to the more rapid development of stenosis. The obstruction of the valve imposes a pressure overload on the LV, which subsequently causes the development of concentric hypertrophy at rates that vary individually.
Ventricular hypertrophy is a key adaptive mechanism to counter pressure overload as it normalizes wall stress.
However, it also has adverse consequences: an increase in the total collagen volume of the myocardium; a reduction of LV compliance leading to a limited preload reserve; and myocardial ischaemia with symptoms of angina, which may be present even when coronary disease is not, and is caused by the combination of increased myocardial oxygen p.
In addition, reduced systemic arterial compliance is a frequent occurrence in elderly patients with AS and independently contributes to increased afterload and decreased LV function. Late in the course of the disease, cardiac output, and therefore the transvalvular gradient, declines, whereas the pressures in the left atrium and pulmonary artery rise.
In advanced stages of disease, secondary pulmonary hypertension may result in right heart failure. Frequently, the diagnosis is made when a systolic murmur is detected during a routine physical examination or on an echocardiographic examination for another reason. AS is gradually progressive and symptoms usually appear between the second and fourth decade in rheumatic AS, the fifth and sixth decade in patients with bicuspid valves, and the seventh or eighth decade in degenerative aetiology see Chapter 1.
The most common initial symptom is exertional dyspnoea or fatigue.This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.
Medically reviewed by Drugs. Last updated on Feb 3, Aortic stenosis is a condition where the aortic valve in your heart is narrowed. The aortic valve is between the left ventricle and the aorta. The left ventricle is the lower left chamber of your heart. The aorta is a blood vessel that pumps blood to your head and body. The aortic valve opens and closes to direct blood flow through your heart. When the aortic valve is narrowed, blood flow may decrease. Your tissues and organs will not have enough oxygen and nutrients to function properly.
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Aortic Stenosis Overview
Get the plugin now. Toggle navigation. Help Preferences Sign up Log in. To view this presentation, you'll need to allow Flash. Click to allow Flash After you enable Flash, refresh this page and the presentation should play. View by Category Toggle navigation. Products Sold on our sister site CrystalGraphics. Title: Aortic Stenosis in Pregnancy. Description: Day 3 post-forceps delivery patient transferred home with 6 week follow-up with cardiology for possible valve replacement.
Tags: aortic delivery forceps pregnancy stenosis. Latest Highest Rated. Pt followed for change in symptoms. Mid Oct.
AORTIC STENOSIS - PowerPoint PPT Presentation
Velocity waveform is asymmetric which usually equates with less than severe stenosis. If vaginal delivery, must avoid valsalva. Small doses of intrathecal LAs added to narcotics improve analgesia while limiting hemodynamic consequences. Would not effectively control the pain from second stage of labor and therefore would not attenuate the increase in HR associated with delivery. During the first stage of labor, the pain of uterine contractions is transmitted via spinal cord segments.
Ready for delivery in AM with forceps No valsalva by mother and epidural working well with slow dosing. PCWP and urine output maintained throughout delivery with fluids and gentle epidural dosing. Stable vital signs throughout hospital stay. Day 3 post-forceps delivery patient transferred home with 6 week follow-up with cardiology for possible valve replacement. Only 18 of patients are alive 5 years after the peak systolic gradient is gt50mmHg or the orifice lt0.
If SBP is decreased the patient can develop subendocardial ischemia Early alpha-adrengic agonists needed as treatment PVR this stays normal until very late in the disease process 48 Toronto study of 49 pregnancies in women with AS Mild AS gt1. Resection of her subaortic membrane was performed 17 months after delivery. The third pt had a bicuspid valve AVA. She underwent a Ross procedure 18 months postpartum. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis.
Pregnancy in patients with heart diseaseexperience with cases. Maintain HR Bradycardia decreases CO in pt with fixed stenotic lesion and tachycardia does not allow for diastolic filling of ventricles. Generous preload maintain at normal to high range. Be prepared for cardioversion urgently Lidco may be useful No Valsalva and minimize pain. These could affect preload and sympathetic response HR, BP and worsen her condition acutely.Aortic stenosis is one of the most common and most serious valve disease problems.
Aortic stenosis is a narrowing of the aortic valve opening. Watch an animation of aortic valve stenosis. Although some people have AS as a result of a congenital heart defect called a bicuspid aortic valvethis condition more commonly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through the valve. No, not always.
It's important to note that many people with AS do not experience noticeable symptoms until the amount of restricted blood flow becomes significantly reduced. It may be important to note that the person suffering from AS may not complain of symptoms. However, if family members notice a decline in routine physical activities or significant fatigue, it is worth a visit to your healthcare provider to check for the possibility of reduced heart function. Infants and children, who have aortic stenosis due to a congenital defectmay exhibit symptoms such as:.
In addition to the symptoms of aortic stenosis, which may cause a patient to feel faint, weak, or lethargic, the wall of the left ventricle may also show muscular thickening because the ventricle must work harder to pump blood through the narrow valve opening into the aorta.
The thickened wall takes up more space inside the lower heart chamber which allows less room for an adequate amount of blood to be supplied to the body, which in turn may cause heart failure. Early treatment can help to reverse or slow down the progress of this disease. Aortic stenosis mainly affects older people - the result of scarring and calcium buildup in the valve cusp flap or fold.
Age-related aortic stenosis usually begins after age 60, but often does not show symptoms until ages 70 or Another cause may be that the valve opening does not grow along with the heart, which makes the heart work harder to pump blood to the restricted opening. Over the years the defective valve often becomes stiff and narrow because of calcium build-up. If there are no symptoms or if symptoms are mild, a healthcare provider may advise that the best course of action is to simply monitor and follow up on any changes.
However, anyone with aortic stenosis should be checked with an echocardiogram heart ultrasound to confirm the safest and best options for treatment.
Conversely, even if no symptoms are present, it may be advisable to proceed with treatment or repairs based on the test results. If consensus is reached and surgery is recommended, it is important to proceed without postponing this important treatment.
Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way. Heart Valve Problems and Disease. About Heart Valves.
Aortic Stenosis in Pregnancy - PowerPoint PPT Presentation
Heart Valve Problems and Causes. Getting an Accurate Diagnosis. Treatment Options. Recovery and Healthy Living Goals. Personal Stories. Heart Valve Disease Resources. Warning signals can include chest pain, shortness of breath and fatigue. It's natural to feel a bit overwhelmed by your diagnosis. But hats off to you for taking charge! We can help you get started. And you and your doctor can chart a path for your success. Working with your healthcare team to understand your options is important.
We'll help you figure out the basics. When patients have the tools and resources they need to manage their condition, outcomes can be better. What is aortic valve stenosis AS? Does aortic stenosis always produce symptoms? Symptoms of aortic stenosis may include: Breathlessness Chest pain anginapressure or tightness Fainting, also called syncope Palpitations or a feeling of heavy, pounding, or noticeable heartbeats Decline in activity level or reduced ability to do normal activities requiring mild exertion Heart murmur It may be important to note that the person suffering from AS may not complain of symptoms.Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows.
This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from your heart into the main artery to your body aorta and onward to the rest of your body.
When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle. Your treatment depends on the severity of your condition. You may need surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Aortic valve disease care at Mayo Clinic. Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include:. The heart-weakening effects of aortic valve stenosis may lead to heart failure.
Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet. If you have a heart murmur, your doctor may recommend that you visit a cardiologist.
If you develop any symptoms that may suggest aortic valve stenosis, see your doctor. A normal heart has two upper receiving and two lower pumping chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart.
The heart valves, which keep blood flowing in the correct direction, are gates at the chamber openings for the tricuspid and mitral valves and exits for the pulmonary and aortic valves.
In aortic valve stenosis, there is progressive narrowing of the aortic valve opening over time top rowwhich results in increased pressure within the heart and reduced capacity to pump blood to the body. This is similar to attaching smaller and smaller nozzles to the end of a garden hose bottom row. The narrowing from the nozzle slows the forward flow of water and results in progressive pressure buildup within the garden hose.
Aortic valve stenosis is a defect that narrows or obstructs the aortic valve opening, making it difficult for the heart to pump blood into the aorta. Mild cases may not have symptoms initially, but they can worsen over time.
Typically the aortic valve has three cusps tricuspid aortic valvebut some people are born with an aortic valve that has two cusps bicuspid aortic valve. Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve.
Each valve has flaps cusps or leaflets that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.
In aortic valve stenosis, the aortic valve between the lower left heart chamber left ventricle and the main artery that delivers blood from the heart to the body aorta is narrowed stenosis.
When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and your heart overall, and it can ultimately lead to heart failure and other problems. Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps.
Some children are born with an aortic valve that has only two bicuspid cusps instead of three. People may also be born with one unicuspid or four quadricuspid cusps, but these are rare.
This defect may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced.Aortic stenosis AS is narrowing of the aortic valve, obstructing blood flow from the left ventricle to the ascending aorta during systole.
Causes include a congenital bicuspid valve, idiopathic degenerative sclerosis with calcification, and rheumatic fever. Untreated AS progresses to become symptomatic with one or more of the classic triad of syncope, angina, and exertional dyspnea; heart failure and arrhythmias may develop. A crescendo-decrescendo ejection murmur is characteristic. Diagnosis is by physical examination and echocardiography. Asymptomatic AS in adults usually requires no treatment. Once symptoms develop, surgical or percutaneous valve replacement is required.
For severe or symptomatic AS in children, balloon valvotomy is effective. See also Overview of Cardiac Valvular Disorders. Aortic sclerosis is a degenerative aortic valve disease with thickening of aortic valve structures by fibrosis and calcification initially without causing significant obstruction.
Aortic sclerosis resembles atherosclerosiswith deposition of lipoproteins and inflammation and calcification of the valves; risk factors are similar. Patients with psoriasis are at increased risk for atherosclerosis, and more recently psoriasis has been tied to an increased risk of aortic stenosis.
A congenital bicuspid aortic valve. Rheumatic fever. Supravalvular AS caused by a discrete congenital membrane or hypoplastic constriction just above the sinuses of Valsalva is uncommon. A sporadic form of supravalvular AS is associated with a characteristic facial appearance high and broad forehead, hypertelorism, strabismus, upturned nose, long philtrum, wide mouth, dental abnormalities, puffy cheeks, micrognathia, low-set ears. When associated with idiopathic hypercalcemia of infancythis form is known as Williams syndrome.
Subvalvular AS caused by a congenital membrane or fibrous ring just beneath the aortic valve is uncommon. The increased pressure load imposed by aortic stenosis results in compensatory hypertrophy of the left ventricle LV without cavity enlargement concentric hypertrophy. With time, the ventricle can no longer compensate, causing secondary LV cavity enlargement, reduced ejection fraction EFdecreased cardiac output, and a misleadingly low gradient across the aortic valve low-gradient severe AS.
Patients with other disorders that also cause LV enlargement and reduced EF eg, myocardial infarction, intrinsic cardiomyopathy may generate insufficient flow to fully open a sclerotic valve and have an apparently small valve area even when their AS is not particularly severe pseudosevere AS.
Pseudosevere AS must be differentiated from low-gradient severe AS because only patients with low-gradient severe AS benefit from valve replacement. Elevated shear stress across the stenosed aortic valve degrades von Willebrand factor multimers. The resulting coagulopathy may cause GI bleeding in patients with angiodysplasia Heyde syndrome. Congenital aortic stenosis is usually asymptomatic until age 10 or 20 years, when symptoms develop insidiously. In all forms, progressive untreated aortic stenosis ultimately results in exertional syncope, angina, and dyspnea SAD triad.
Other symptoms and signs may include those of heart failure and arrhythmiasincluding ventricular fibrillation leading to sudden death. Exertional syncope occurs because cardiac output cannot increase enough to meet the demands of physical activity. Nonexertional syncope may result from altered baroreceptor responses or ventricular tachycardia.
Exertional angina pectoris affects about two thirds of patients; about half have significant coronary artery atherosclerosis, and half have normal coronary arteries but have ischemia induced by LV hypertrophy and altered coronary flow dynamics. There are no visible signs of aortic stenosis. Palpable signs include carotid and peripheral pulses that are reduced in amplitude and slow rising pulsus parvus et tardus and an apical impulse that is sustained thrusts with the 1st heart sound [S1] and relaxes with the 2nd heart sound [S2] because of left ventricular hypertrophy.
The LV impulse may become displaced when systolic dysfunction develops. A palpable 4th heart sound S4felt best at the apex, and a systolic thrill, corresponding with the murmur of AS and felt best at the left upper sternal border, are occasionally present in severe cases.