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Aortic stenosis Heart failure
Dr.Aso faeq salih
a narrowing of the valve that opens to allow blood to flow from the left ventricle into the aorta and then to the body.
Valvular, subvalvular or supravulvalar – 5%
Failure of :◦ development of the
three leaflets◦ Resorption of tissue
around the valve
Depend on degree of stenosis Mild to moderate : asymptomatic Severe:
◦ easy fatigability, exertional chest pain, syncope◦ In infant with severe stenosis can survive only if:
PDA permits flow to the aorta and coronary arteries
• Physical sign:
– Small volume, slow rising pulse– Sys ejection murmur at Rt 2nd IS and radiating to
neck– ejection click– Thrill at RUS border/suprasternal notch/carotid
• Cong bicuspid aortic valve:– Prone to calcific degeneration in middle age– Increased risk of infective endocarditis
(a) Aortic stenosis. (b) Murmur. (c) Chest X-ray. (d) ECG.
Ballon valvulopasty◦ Symptoms on exercise/ high resting pressure
gradient(>64mmHg)◦ High risk of significant valvular insufficiency
Surgical mx◦ When BV unsuccesful or significant valvular
insufficiency develops Subacute bacterial endocarditis prophylaxis
Salt &water retention by kidney increase pre load .
Vasoconstriction , through Renin / Angiotensin increase after load .
Increased circulating Catecholamine increase C.O .
Increase R.R to promote excretion of Co2 . Increase renal excretion of H- ion &
retention of HCO3 to maintain a normal PH .
The primary determinants of SV :
Pre load (volume work ). After load ( pressure work ) . Contractility (intrinsic myocardial
function )
Cardiac rhythm disorders may be caused by the following:
Complete heart block , Supraventricular tachycardia , Ventricular tachycardia , Sinus node dysfunction
Volume overload may be caused by the following:
1.Structural heart disease (eg, ventricular septal defect,[3] patent ductus arteriosus, aortic or mitral valve regurgitation, complex cardiac lesions)
2.Anemia 3.Sepsis
Pressure overload may be caused by the following:
Structural heart disease (eg, aortic or pulmonary stenosis, aortic coarctation)
Hypertension Systolic ventricular dysfunction or failure
may be caused by the following: Myocarditis , Dilated cardiomyopathy
Malnutrition , Ischemia Diastolic ventricular dysfunction or failure
may be caused by the following: Hypertrophic cardiomyopathy , Restrictive cardiomyopathy ,
Pericarditis , Cardiac tamponade (pericardial effusion)
Depends on the degree of cardiac reserve .
Infants : Feeding difficulties & sweating .Poor weight gain . Irritability & weak cry .Respiratory distress .
Fatigue . Effort intolerance . Anorexia , abdominal pain . Dyspnea . Cough . Orthopnea .
• Respiratory distress .• Increased JVP .• Hepatomegally .• Edema .• Basal crepitation .• Cardiomegaly .• Gallop rhythm .• Holosystolic murmur of mitral ,
tricuspid insufficiency .
CXR cardiac enlargement , pul. vascularity.
ECG : chamber hypertrophy , ischemic changes , rhythm disorders .
Echo : assess ventricular function . Doppler ; calculate C . O . Arterial O2 : may be decreased ( pul.
Edema ) . Blood gas analysis : metabolic & respiratory
acidosis . Electrolyte disturbances : hypo Na , hypo
glycemia .
Underlying cause must be removed or alleviated if possible .
General measures : Adequate sleep & rest . Position : older children semi
upright position infants infant chair . Modification of activities . Diet : increase no. of calories / feeding up to
24 cal/oz, or supplementing breast feeding .
Low Na formula is not recommended . Older children : diet with (no added salt )
& abstinence from food containing high concentration of salts .
Respiratory distress : Semi upright position . Continuous O2 , +ve pressure
ventilation . _ ve inotropic factors should be corrected
: hypoglycemia , hypo Ca , acidosis . Sedation for irritability & excessive
crying . Treatment of associating pul. Infection . Temperature control .
Medications used in treating HF :
Diuretics . Inotropic agents . After load reducing agents .