Aortic Valve Stenosis

The aortic stenosis (AS) is the narrowing of the aortic valve, which leads to the obstruction of the systolic blood flow out of the LV in the ascending aorta. Causes are congenital bicuspid valve, idiopathic degenerative sclerosis with calcification and rheumatic fever. An untreated AS is finally symptomatic progresses, with one or more symptoms of the classical triad of syncope, angina and exertional dyspnea; it can develop heart failure and arrhythmias. A crescendo-decrescendo Ejektionsgeräusch is characteristic. The diagnosis is made because of the physical examination and echocardiography. An asymptomatic AS usually does not require treatment in adults. Once symptoms appear, a surgical or percutaneous valve replacement is required. In severe or symptomatic AS in children, the balloon valvuloplasty is effective.

The aortic stenosis (AS) is the narrowing of the aortic valve, which leads to the obstruction of the systolic blood flow out of the LV in the ascending aorta. Causes are congenital bicuspid valve, idiopathic degenerative sclerosis with calcification and rheumatic fever. An untreated AS is finally symptomatic progresses, with one or more symptoms of the classical triad of syncope, angina and exertional dyspnea; it can develop heart failure and arrhythmias. A crescendo-decrescendo Ejektionsgeräusch is characteristic. The diagnosis is made because of the physical examination and echocardiography. An asymptomatic AS usually does not require treatment in adults. Once symptoms appear, a surgical or percutaneous valve replacement is required. In severe or symptomatic AS in children, the balloon valvuloplasty is effective.

(See also Overview of the heart valve diseases.) The aortic valve stenosis (AS) is the narrowing of the aortic valve, which leads to the obstruction of systolic blood flow out of the LV into the ascending aorta. Causes are congenital bicuspid valve, idiopathic degenerative sclerosis with calcification and rheumatic fever. An untreated AS is finally symptomatic progresses, with one or more symptoms of the classical triad of syncope, angina and exertional dyspnea; it can develop heart failure and arrhythmias. A crescendo-decrescendo Ejektionsgeräusch is characteristic. The diagnosis is made because of the physical examination and echocardiography. An asymptomatic AS usually does not require treatment in adults. Once symptoms appear, a surgical or percutaneous valve replacement is required. In severe or symptomatic AS in children, the balloon valvuloplasty is effective. Etiology in the elderly, is the most common precursor to aortic stenosis aortic sclerosis The Aortenklappensklerose is a degenerative disease of the aortic valve with thickening of the aortic valve structures by fibrosis and calcification, which initially does not cause significant vasoconstriction. With no less than 15% of patients Aortenklappensklerose progresses over several years for aortic stenosis. The Aortenklappensklerose similar to atherosclerosis with deposition of lipoproteins and inflammation and calcification of the valve; the risk factors are similar. Patients with psoriasis have an increased risk of atherosclerosis and recently psoriasis has been associated with an increased risk of aortic stenosis. In patients <70 years, the most common cause of aortic stenosis Congenital ikuspidale aortic valve Congenital aortic stenosis occurs in 3-5 / 1000 births and affects more men; it is associated with coarctation of the aorta and progressive enlargement of the ascending aorta, whereby a dissection occurs. In developing countries, the most common cause is in all age groups Rheumatic fever The supravalvular AS, which is caused by a discrete congenital hypoplastic membrane or a constriction just above the sinus of Valsalva, is rare. A sporadic form of the supravalvular AS is provided with a characteristic expression associated (high and wide end, Hypertelorism, strabismus, raised lug, long philtrum, further mouth, tooth changes inflated cheeks, Micrognathia, low-set ears). If it is associated with idiopathic hypercalcemia in childhood, this form is known as Williams syndrome. The subvalvular AS, which is caused by a congenital membrane or a fibrous ring just below the aortic valve, is rare. Pathophysiology aortic regurgitation may accompany the AS and about 60% of patients with significant AS have> 60 years are also a Mitralringverkalkung that can lead to mitral regurgitation. The increased pressure load through the aortic stenosis leads to a compensatory hypertrophy of the left ventricle (LV) cavity without extension (concentric hypertrophy). Over time, the compensation by the ventricle is no longer possible, resulting secondary to enlargement of the left ventricular cavity, the reduction of the ejection fraction (EF), a decrease in cardiac output and a misleading low gradient across the aortic valve (heavy AS low pressure gradients). In patients with other diseases, which also lead to LV enlargement and reduced EF (z. B. myocardial infarction, intrinsic cardiomyopathy), the blood flow may be too weak to open a sclerotic aortic valve completely and there may be a seemingly small valve orifice area present, even if the aS is not particularly serious (pseudo severe aS). A pseudo severity AS must be distinguished from severe AS with low pressure gradient as a valve replacement is useful only for patients with this type. The increased shear stress on the narrowed aortic valve reduces the von Willebrand factor multimers. The resulting coagulopathy may result in patients with angiodysplasia gastrointestinal bleeding (Heyde’s syndrome). Aortic stenosis var model = {thumbnailUrl: ‘/-/media/manual/professional/images/aortic_stenosis_high_blausen_de.jpg?la=de&thn=0&mw=350’ imageUrl: /-/media/manual/professional/images/aortic_stenosis_high_blausen_de.jpg ‘? lang = en & thn = 0 ‘, title:’ aortic stenosis’, description: ” credits’ ‘, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); Symptoms and complaints Congenital AS is usually up to the age of 10 or 20 years, if the symptoms develop insidiously, asymptomatic. In all forms, the progressive, untreated aortic stenosis eventually leads to Belastungssynkope, angina and dyspnea (Triassic). Other symptoms and findings include heart failure and arrhythmias incl. Ventricular fibrillation leading to sudden cardiac death. The Belastungssynkope arises because the cardiac output can not be increased enough to match the need of physical activity. A load-independent syncope can be caused by an altered Barorezeptorenantwort or ventricular tachycardia. A angina affects about two thirds of patients; about half have a significant CAD, the other half has normal coronary arteries, but induced LV hypertrophy ischemia and changes in coronary blood flow. There are no visible signs of aortic stenosis. Palpation include the carotid and peripheral pulses, which is reduced in amplitude and slowly rising are (pulsus parvus, mollus et tardus), and a persistent heart’s impulse (impact with the first heart sound [S1] and relaxes with the second heart sound [ S2]) as a result of left ventricular hypertrophy. The heart’s apex may shift when an systolic dysfunction develops. A palpable fourth heart sound (S4) which is best palpated at the apex, and a systolic thrill that corresponds to the sound of the AS and is best sampled at the left upper sternal edge, are sometimes present in severe cases. Systolic blood pressure can even be high when the AS is difficult, but eventually falls when the left ventricle fails. On auscultation is normal S1 and S2 singular, since the closing of the aortic valve is delayed and merges with the pulmonary (P2) of component S2. The aortic component may also be weak. It can be heard a paradoxical cleavage of S2. A normally split S2 is the only physical findings that can reliably exclude a severe AS. An S4 may be heard. An ejection click may be heard with congenital bicuspid aortic valve early to S1 in patients when the valve leaflets are stiff but not completely immobile. The click does not change during dynamic maneuvers. The characteristic finding is a crescendo-decrescendo ejection sound that is best heard with the diaphragm of the stethoscope on the right and left upper sternal when the upright seated patient leans forward. The sound radiates (left often louder than the right) typically to the right shoulder blade and in both carotids and has a rough or creaking character. In elderly patients, but the vibration of the unfused crests of the calcified aortic valve leaflets may be a loud, higher-frequency “cooing” or propagating a musical tone to the heart apex, a weakening or lack of the parasternalen noise (Gallavardin phenomenon), which in this way the mitral regurgitation imitated. The sound is quiet at less severe stenosis, it is louder when the stenosis is increased, and reached the maximum volume later in the systole (d. E. The crescendo phase is longer and the decrescendo phase shorter) when the stenosis is higher grade. When the LV function decreases at the critical AS, the noise is quieter and shorter. The intensity of the noise can therefore be misleading in the circumstances. Crescendo-decrescendo murmur. 6. The impact in the example is a ventricular extrasystole (VES). 7. The impact shows a post-VES-amplification of the noise due to increased left ventricular filling during the compensatory pause after PVC, increased flow turbulence behind the narrowed flap caused during the next ventricular contraction. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘player..’); ko.applyBindings ({MediaUrl ‘/-/media/manual/professional/sounds/aortic_stenosis_crescendo_decrescendo_murmur_de.mp3?la=de&thn=0&mw=350’, Mime Type: ‘audio / wav’}, playerPanel.get (0)); Aortic-noise (crescendo decrescendo ejection noise) Recording courtesy of Jules Constant, M.D. The sound of the aortic valve stenosis typically increases during maneuvers which increase the LV volume and contractility, (hochlegen z. B. legs, squatting position, releasing the Valsalva maneuver, after a premature beat) and decreases during maneuvers, the LV the -volume reduce (Valsalva maneuver), or the afterload increase (isometric handle). These dynamic maneuvers have the opposite effect on the noise occurring at a hypertrophic cardiomyopathy, which can otherwise be similar to an AS. The murmur of mitral regurgitation due to prolapse of the posterior valve leaflet can also imitate an AS. Diagnosis Echocardiography diagnosis or aortic stenosis is suspected clinically and by echocardiography. approved. The two-dimensional transthoracic echocardiography is used to detect the stenotic aortic valve and possible causes to quantify the LV hypertrophy and the extent of systolic dysfunction and to identify co-existing valvular heart disease (aortic regurgitation, mitral valve) and complications (eg. As endocarditis) , The Doppler echocardiography is used to determine the degree of stenosis by measuring the speed of blood flow, the transvalvular pressure gradients and the aortic valve. The severity of aortic stenosis is as follows echocardiography in Moderate: Peak Aortenstrahlgeschwindigkeit of 3-4 m / s, average gradient of 20-40 mmHg, valve range 1.0-1.5 cm2 Severe: peaks of Aortenstrahlgeschwindigkeit> 4 m / s, average gradient> 40 mmHg, valve area <1.0 cm2 Very difficult: summit of Aortenstrahlgeschwindigkeit>. 5 m / s, average gradient> 60 mmHg A clinical assessment is used to resolve any disagreement between these parameters (eg moderate valve area, but heavy durchschnttlicher gradient). When the LV function is normal, the valve area is on ungenausten. Aortic stenosis echocardiogram provided by Paul Tanser, M.D. var model = {videoId: ‘4306392391001’, playerId ‘SyAEZ6ptl_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4306433335001_vs-55835388e4b0bdeddf1e4835-767904719001.jpg?pubId=3850378299001&videoId=4306392391001’ title: “aortic stenosis”, description: ‘ u003Ca id = “v38401552 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eZweidimensionales echocardiogram

Health Life Media Team

Leave a Reply