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 .