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Aortic stenosis
Heart failure
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Dr.Aso faeq salih
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a narrowing of the valve
that opens to allow blood
to flow from the left
ventricle into the aorta
and then to the body.
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Valvular,
subvalvular or
supravulvalar – 5%
Failure of :
◦ development of the
three leaflets
◦ Resorption of tissue
around the valve
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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
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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
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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.
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Ballon valvulopasty
◦ Symptoms on exercise/ high resting pressure
gradient(>64mmHg)
◦ High risk of significant valvular insufficiency
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Surgical mx
◦ When BV unsuccesful or significant valvular
insufficiency develops
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Subacute bacterial endocarditis prophylaxis
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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
 Pre
primary determinants of SV :
load (volume work ).
 After load ( pressure work ) .
 Contractility (intrinsic myocardial function )
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Cardiac rhythm disorders may be caused by
the following:
Complete heart block , Supraventricular tachycardia ,
Ventricular tachycardia , Sinus node dysfunction
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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
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Pressure overload may be caused by the
following:
Structural heart disease (eg, aortic or pulmonary stenosis,
aortic coarctation)
Hypertension
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Systolic ventricular dysfunction or failure may
be caused by the following:
Myocarditis , Dilated cardiomyopathy
Malnutrition , Ischemia
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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 .
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Fatigue .
Effort intolerance .
Anorexia , abdominal pain .
Dyspnea .
Cough .
Orthopnea .
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Respiratory distress .
Increased JVP .
Hepatomegally .
Edema .
Basal crepitation .
Cardiomegaly .
Gallop rhythm .
Holosystolic murmur of mitral , tricuspid insufficiency .
 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 .
 CXR
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 .
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 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
 Diuretics
used in treating HF :
.
 Inotropic agents .
 After load reducing agents .