Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Valvular Heart Disease Aortic Stenosis (AS) 1511

Loud

Post-PVC beat; loudness of murmur increases

Systolic click (associated with opening of valve)

A2 increased

➣As AS progresses: Murmur peaks later; thrill may be present

Murmur becomes soft and may be absent later in course

Single S2 due to absence of A2.

■Carotid Upstroke – delayed and decreased, but can be normal

■PMI – forceful

tests

ECG

■Left atrial abnormality

■Left ventricular hypertrophy (LVH)

Chest X-Ray

■Normal heart size or “Boot-shaped” heart (due to LVH)

■Calcification of aortic valve (best seen in lateral view)

■Post-stenotic dilation of the aorta

■Pulmonary venous congestion may be present

Echo/Doppler

(If any symptoms, echo/Doppler should be obtained)

■Decreased aortic valve leaflet mobility

■Systolic gradient across aortic valve

■Quantitate aortic valve area

■Degree of LVH

■LV systolic function

■Mitral valve leaflets and mobility (can provide information concern-

ing etiology of AS)

Cardiac Catheterization

■Right heart catheterization – pulmonary capillary wedge pressure to

assess LV function (provided mitral valve function is normal)

■Quantitate LV/aortic systolic gradient

■Gorlin formula: calculate aortic valve area using cardiac output and

mean aortic valve gradient

■Elevated LV end-diastolic pressure (LVEDP) – due to decreased com-

pliance of hypertrophied LV wall

■Coronary angiography – assess presence of stenoses in coronary

arteries (Required by CT surgery prior to aortic valve replacement)