The Intern At Work: Internal Medicine 4. The Tight Valve - Part 2: Aortic Stenosis
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Jun 17, 2018 In this episode, they discuss the physical exam, work-up, and management of aortic stenosis, including TAVI approaches and aortic valve replacement indications. They highlight Class 1A indications for valve replacement and different strategies for severe aortic stenosis management.
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Key Physical Signs of Aortic Stenosis
- Classic aortic stenosis presents with a systolic ejection murmur loudest at the right upper sternal border, radiating to the carotid artery.
- Severe aortic stenosis features include late-peaking murmur, soft or absent S2, slow rising carotid pulse, and sustained apical impulse.
Maneuvers to Differentiate Murmurs
- Differentiate aortic stenosis murmur from mitral regurgitation and hypertrophic obstructive cardiomyopathy using maneuvers affecting preload and afterload.
- Use handgrip to raise afterload and squatting/standing to change preload for murmur distinction.
Complications of Aortic Stenosis
- Aortic stenosis can cause complications like heart block, GI bleeding from angiodysplasia, and increase risks of endocarditis and embolism.
- This bleeding risk is linked to acquired von Willebrand disease known as Hadie's syndrome.