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What are the complications of aortic stenosis ?

What are the complications of aortic stenosis ?

• Left ventricular failure indicates poor prognosis unless the valve is replaced.

• Sudden death occurs in 10-20% of adults and I% of children. It has been rarely documented to occur
without prior symptoms. It is an uncommon event -probably <1% per year.

• Arrhythmias and conduction abnormalities include ventricular arrhythmias (more common than
supraventricular arrhythmias) and heart block (may occur because of calcification of conducting tissues).

• Systemic embolization is caused by disintegration of the aortic valve apparatus or by concomitant aortic atheroma.

• Infective endocarditis (in 10% of cases) should be considered when these patients present with
unexplained illness.

• Haemolytic anaemia.

What is the mechanism of syncope in aortic stenosis ?

What is the mechanism of syncope in aortic stenosis ? 

• The left ventricle is suddenly unable to contract (transient electro-mechanical dissociation) against the stenosed valve. 

• Cardiac arrhythmias (bradycardia, ventricular tachycardia or fibrillation). 

• Marked peripheral vasodilatation without a concomitant increase in cardiac out-put. particularly after exercise.

Does the loudness of the murmur reflect the severity of the aortic stenosis ?

Does the loudness of the murmur reflect the severity of the aortic stenosis ? 

No, the loudness of the murmur is related more to the cardiac output and the systolic turbulence surrounding the valve than to the severity of the stenosis. Thus, a loud murmur may be associated with trivial stenosis and, in severe heart failure, the mur-mur may be soft because of decreased flow across the valve from the diminished cardiac output.

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