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Symptoms of aortic stenosis (AS)

Important symptoms of AS are
1.    Exertional angina
2.    Exertional syncope
3.    Exertional dyspnea
What is the mechanism of dyspnoea in AS.
          Dyspnoea in AS is due to left ventricular dysfunction resulting in elevated pulmonary capillary pressure.
What is the mechanism of angina in AS
          Angina occur due to the imbalance between myocardial oxygen supply and demand.
1.    There is increased myocardial oxygen demand due to left ventricular hypertrophy (LVH).
2.    Decreased blood supply is due to an increase in left ventricular end diastolic pressure which decreases the coronary perfusion gradient.
What is the mechanism of syncope in aortic stenosis
          Syncope is due to reduction  in cerebral blood flow.
Mechanisms are
1.    Systemic vasodilation against a fixed cardiac output
2.    Transient atrioventricular arrhythmia
3.    Transient AV block
4.    Vasodepressor response due to baroreceptor malfunction
How will you correlate the development of symptoms with survival in AS
Duration of survival
5 yrs
3 yrs
2 yrs
Cardiac failure
Describe the other presentations of AS
          Other presentations of AS are
-          Cardiac failure (CCF)
-          Infective endocarditis (IEC)
-          Sudden cardiac death - it may be due to complete heart block or atrial tachyarrhythmia
-          Gastrointestinal bleeding
What is the mechanism of CVA in AS
1.    Due to embolism from thrombi in valve
Why gastrointestinal bleeding occur in AS
 Angiodysplasia, particulary in persons with calcific AS. A pure aortic valve disease may remain asymptomatic for 10-15 years.