Review Question - QID 106831

This patient presents with aortic stenosis (AS). On a pressure-volume (PV) loop, elevated left ventricular pressures as well as decreased stroke volumes will be observed as seen in Figure B.

Aortic stenosis is the most common valvular disease in the world and occurs when the aortic valve becomes narrowed. It is commonly caused by age related calcification of the valve leaflets and presents when patients are in the 60's or 70's. It produces the characteristic crescendo-decrescendo systolic murmur preceded by an ejection click. On PV curve, the increased afterload caused by AS will produce increased LV pressure, decreased stroke volume, and an increase end systolic volume as observed in Figure B. Ultimately, aortic valve replacement is the treatment of choice for symptomatic patients.

Grimard et al. review the diagnosis and management of aortic stenosis. They state that as the disease worsens, compensatory mechanisms of the heart become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement should be recommended in most patients with any of these symptoms accompanied by evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients, including those with hemodynamically significant aortic stenosis.

Shipton et al. review the management of valvular heart disease. They state that people with valvular heart disease are living longer, with less morbidity, than ever before. Advances in surgical techniques and a better understanding of timing for surgical intervention account for increased rates of survival. Echocardiography remains the gold standard for diagnosis and periodic assessment of patients with valvular heart disease. Generally, patients with stenotic valvular lesions can be monitored clinically until symptoms appear.

Figures are described below in the incorrect answer choice explanations. Illustration A shows an idealized pressure volume loop featuring cardiac cycle components.

Incorrect Answers:
Answer 1: Figure A is the PV loop that would be associated with mitral stenosis. Note the decreased LV volumes caused by a decrease in preload.
Answer 3: Figure C is the PV loop that would be observed in mitral regurgitation. Note the increased LV volumes that occur as a result of the increased volumes secondary to the regurgitant flow.
Answer 4: Figure D is the PV loop that would be observed in aortic regurgitation. Note both the increased LV volume and pressures that occur in AR due to the increased regurgitant flow into the left ventricle.
Answer 5: Figure E demonstrates a normal PV loop.