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Medicine

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Cardiology

Question
14 out of 30
 

Sudden death can occur in? (AIPG 2012)



A MS
B MR

C AS
D AR

Ans. C

AS

Aortic stenosis (AS)

Causes:

1. Senile calcification

2. RHD

3. Congenital (bicuspid valve, William's syndrome.) Q

Presentation May be asymptomatic Qor Classical triad Q:

1. Angina

2. Dyspnea

3. Syncope

Others symptoms

1. Dizziness

2. CCF

3. Sudden death Q.

Signs:

1. Slow rising pulse (diminished and delayed carotid upstroke-'parvus et tardus' Q)

2. Narrow pulse pressure

3. Heaving apex beat;

4. Aortic thrill

5. Ejection systolic murmur Q heard at i) apex ii) left sternal edge iii) the aortic area, radiates to the carotids.

6. Gallavardin phenomena is seen AS.

7. Reversed splitting of S2.


8. There may be an ejection click (pliable valve)

9. S4

10. S3



Tests:

ECG: LVH with strain pattern.

CXR: calcified aortic valve; post-stenotic dilatation of ascending aorta.

Echo: diagnostic

Management: If symptomatic, prognosis is poor: ( 2-3yr survival if angina/syncope, 2yr Q if cardiac failure Q).

1. Prompt valve replacement is recommended.

2. Asymptomatic patients with severe AS and a deteriorating ECG, valve replacement also recommended.

3. If the patient is not medically fit for surgery, percutaneous valvuloplasty may be attempted.

Prognosis –

Average time to death after onset of symptoms –

1. CHF – 1yrs

2. Angina – 2yrs

3. Syncope – 3yrs

Extra Edge:Heyde syndrome (Hari-18th pg 972)

Heyde's syndrome (aortic stenosis with gastrointestinal bleeding) is attributed to the presence of angiodysplasia of the gastrointestinal tract in patients with aortic stenosis. It susceptible to serum proteases.

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