0071643192.pdf

Aortic Stenosis (AS)

The most common causes are calcific valve degeneration (patients over 65 years),

congenital bicuspid valve (younger patients), and rheumatic heart disease

(less common). Rheumatic aortic stenosis should be suspected if there is con-

comitant mitral valve disease.

PATHOPHYSIOLOGY

■ Blood flow from the left ventricle is hindered →LVH, ↓cardiac output,

and eventual dilated cardiomyopathy with hypertrophy

■ There are usually no signs or symptoms until the aortic outflow tract is

reduced by at least 75% (to <1 cm).

■ Survival is 2–5 years from onset of symptoms without definitive treatment.

CARDIOVASCULAR EMERGENCIES

TABLE 2.18. Valvular Lesions With Associated Physical Findings

COMMON

VALVULARLESION ETIOLOGIES MURMUR PHYSICALFINDINGS

Aortic stenosis Calcific valve Crescendo-decrescendo Paradoxically split S2

degeneration systolic Narrowed pulse pressure

Bicuspid aortic Radiating →neck Diminished and

valve (<65 yrs) slow-rising carotid pulse

Aortic Acute Blowingdiastolic Acute

regurgitation Endocarditis Heard best at left Pulmonary edema and

Aortic dissection sternal border CV collapse

Chronic Chronic

Rheumatic heart Widened pulse pressure

disease Rapid and ↓of carotid

Bicuspid aortic pulse

valve Nail pulsations

To-and-fro murmur over

femoral artery

Soft mid-diastolic rumble

Mitral stenosis Rheumatic Diastolic Loud S1

heart disease Heard best at apex

Mitral Acute Loudholosystolic Acute

regurgitation Endocarditis Heard best at apex Pulmonary edema and

ACS Radiating →base CV collapse

Chronic Chronic

Rheumatic LV heave

heart disease

Mitral valve Unknown, likely Late systolic Early to mid systolic click

prolapse congenital Heard best at

left lateral heart

border

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