Wed3November0844PM 5

Are the following statements correct for aortic stenosis?

True / False

May be severe even in the absence of a murmur Correct

May be severe even if the gradient across the aortic valve is only 30 mmHg Correct

Syncope typically occurs after exertion Correct

May be associated with reverse splitting of the second heart sound Correct

Angina means that coronary artery disease is also present Correct

Explanation

Syncope will generally occur during exertion due to an imbalance between coronary supply and demand. This is also the cause of angina associated with stenosis.

The presence of a murmur needs good LV function, and thus in end-stage stenosis when LV function is poor, the murmur may reduce in intensity.

The second heart sound (S2) can be split. It is caused by first the closure of the aortic valve (A2) followed by the closure of the pulmonary valve (P2). The split is most likely to be heard during the expiratory phase.

A reverse splitting of S2 is abnormal and is pathological. The aortic valve closure is delayed and follows P2. It is likely to occur in patients with aortic stenosis, left bundle branch block (LBBB), and a ventricular pacemaker and hypertrophic cardiomyopathy.

A severe gradient across a valve is classed as above 50 mmHg, however, the severity grading can also be made on a valve area. In this case, despite a lower gradient, a patient could be classed as having severe aortic stenosis.

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