A presentation that discussed a case of aortic stenosis

1. CASE B: AORTIC STENOSIS
Presented by: Arwa Al-
Onayzan.
Group: 6
Serial number: 66.

2. OUR CASE
 A 85 yo female, have edema, tired, has dyspnea at rest.
 She has angina and almost faints (no full collapse).
 Medical history: no cardiac disease.
 Physical examination:
 BP= 145/85 mmHg, weak pulse, HR= 66/min.
 Thrill over carotid artery.
 Second heart sound is feeble, loud systolic murmur in right 2
intercostal space.
 Normal lung with no edema.

3. QUESTION
 How can these observations be explained?
 Which additional examinations would you suggest and why?

4. INTRODUCTION
 What is aortic stenosis??
 Is inability of aortic valve to open during systole.
 Etiology??
 Senile aortic stenosis (calcification).
 Rheumatic fever (fibrosis).
 Hyperlipidemia (deposition of fat).

5. HOW CAN THESE OBSERVATIONS
BE EXPLAINED?

6. HOW CAN THESE OBSERVATIONS
BE EXPLAINED?
Observation in
the case
Explanation
• She is
complaining of
edema.
• 70% of blood is in the vein.
• Pressure inside heart increase because of stenosis.
• Blood in vein can’t enter heart  high hydrostatic
pressure  edema.
• She is tired, has
dyspnea at rest,
has angina and
almost faint
• Blood in left side can’t goes out because aortic
stenosis.
• Leading to severe low cardiac output.
• Low blood (low O2)  dyspnea, low blood to muscle
 tired.
• Low blood to heart  angina, low blood to brain 
faint.

7. CON…
Observation in
the case
Explanation
• Increase BP=
145/85 mmHg
• Blood can’t goes out from the narrowed valve.
• Leading to increase BP to pump blood out.
• Her pulse is weak
with HR= 66
beat/min
• Blood in left side can’t goes out because aortic
stenosis.
• Leading to low cardiac output  weak pulse and HR.
• Thrill over the
carotid arteries,
loud systolic
murmur in 2nd
(IC)
• Blood can’t goes out from the narrowed valve during
systole.
• Creating abnormal sound (ESM).
• And thrill over the carotid.

8. QUIZ TIME!
 Q1) give me 2 symptoms of aortic valve stenosis?

9. WHICH ADDITIONAL EXAMINATIONS
WOULD YOU SUGGEST AND WHY?

10. DIAGNOSIS OF AORTIC STENOSIS
 To make diagnosis we need:
1. Medical history.
2. Physical examination.
3. Investigation.
 Physical examination:
• Auscultation of the heart.
 Murmur of aortic stenosis is a high-pitched, "diamond shaped"
crescendo-decrescendo, midsystolic ejection murmur.
 Heard best at the 2end right upper sternal border radiating to the
neck and carotid arteries.

11. INVESTIGATION
 Echocardiogram:
• It uses sound waves to produce an image of the heart.
• This is the primary test to diagnosis AS.
• Evaluate the severity.
 Electrocardiogram (ECG):
• Record action potential in the heart.
• Left ventricular hypertrophy.

12. CON…
 Chest X-ray:
• Shows LVH.
• Reveal calcium deposits on the aortic valve.
• Check the lungs (lung congestion)
 Cardiac catheterization:
• Uses tube or catheter and insert it to artery.
• Inject dye to artery and use X-ray to reveal it.
• show any blockages in arteries can coexist with aortic valve
stenosis that may need surgical treatment along with aortic
valve stenosis.

13. CON…
 Exercise tests:
• Done to asymptomatic patients.
• To evaluate how the heart responds to exercise.
• And to measure your tolerance for activity.
 Computerized tomography (CT) scan:
• Measure the size of the aorta and look at aortic valve.
• May inject a dye into blood vessels to show the blood flow (CT
angiography).

14. CON…
 Magnetic resonance imaging (MRI):
• Uses powerful magnets and radio waves to create detailed
images of heart and heart valves.
• May inject a dye into your blood vessels to highlight the heart
and blood vessels in images (magnetic resonance angiography).
• Uses to measure the size of the aorta.
 B-type Natriuretic Peptide:
• It provide incremental prognostic information in predicting
symptom onset in asymptomatic patients with severe aortic
stenosis.

15. LAP TEST
 Serum electrolyte levels.
 Cardiac biomarkers.
 Complete blood count.
 Arterial blood gas.

16. QUIZ TIME!
Q1) give 2 example of investigation of the AS??

17. SUMMARY
Aortic
stenosis
Explanation
of
observations
Investigation
DefinitionCauses
General
mechanisms

18. ANY QUESTION?

20. REFERENCE
 Merk Manual (19 Edition), (Page 2200-2203).
 Kumar & Clark’s Clinical Medicine Book (Ninth Edition), (Page
1049- 1050).
 Aortic Stenosis Workup. MD, E. S. (2016, Dec. & jan.), from
http://emedicine.medscape.com/article/150638-overview.