Aortic Stenosis vs Idiopathic Calcified Aortic Stenosis - USMLE Forums
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  #1  
Old 07-01-2011
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Heart Aortic Stenosis vs Idiopathic Calcified Aortic Stenosis

a 54 y old man with syncope with crescendo decrescendo murmur at 2nd lft ics with murmur radiating to carotid artery,narrow pulse,softs2,normal bp

how to know whether it is as or idiopathic calcified aortic stenosis...
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how to differentiate both conditions???any answer will be helpful
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The most unique feature of HOCM is that its murmur will increase in intensity after valsalva maneuver.
Others include: 1.In AS we have pulsus parvus et tardus while in HOCM we have pulsus bisferiens
2.Murmur of AI may accompany AS while this is not the case in HOCM
3.aortic dilatation and aortic valve calcification are also seen only in AS.
4.There is a concenteric hyperterophy of LV in AS while this is asymmetric septal hypertrophy in HOCM
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Old 07-03-2011
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Quote:
Originally Posted by amirh899 View Post
The most unique feature of HOCM is that its murmur will increase in intensity after valsalva maneuver.
Others include: 1.In AS we have pulsus parvus et tardus while in HOCM we have pulsus bisferiens
2.Murmur of AI may accompany AS while this is not the case in HOCM
3.aortic dilatation and aortic valve calcification are also seen only in AS.
4.There is a concenteric hyperterophy of LV in AS while this is asymmetric septal hypertrophy in HOCM
thanks...but my doubt is that with above features we have to put diagnosis as aortic stenosis or idiopathic calcified aortic valve stenosis(icav)...bcoz we call it icav when patient is old like 70 or above...so as vs icav not hocm...but thanks for answering
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Old 07-03-2011
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Your patient has murmur at 2nd lics while in HOCM the murmur is best heard at apex
Your patient has radiation of murmur to neck, while murmur of HOCM never radiates to neck but may radiate to axilla
Your patient has a narrow pulse while the pulse in HOCM is typically bifid.
Systolic cres-decres murmur as well as chest pain, syncope, CHF are common between these two conditions.
Hope these help
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Help related question :D

Since the topic is about aortic stenosis and I dont seem to find the answer/explanation anywhere, I want to ask a question that is related to it

Is aortic stenosis associated with narrow (low) or wide (high) pulse pressure ? Why ? and what is the mechanism ?
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Quote:
Originally Posted by drzamzam View Post
Since the topic is about aortic stenosis and I dont seem to find the answer/explanation anywhere, I want to ask a question that is related to it

Is aortic stenosis associated with narrow (low) or wide (high) pulse pressure ? Why ? and what is the mechanism ?

yes in aortic stenosis more pressure in left ventricle and across valve area due to volume overload and due to aortic stenosis--> less cardiac output so so narrow pulse pressure .
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Warning! ???

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Originally Posted by confident View Post
yes in aortic stenosis more pressure in left ventricle and across valve area due to volume overload and due to aortic stenosis--> less cardiac output so so narrow pulse pressure .
But isn't pulse pressure = the difference between systolic and diastolic pressure. In case of aortic stenosis, systolic is high (more pressure is required to case a change in volume) and diastolic is low (less blood volume in aorta) thus pulse pressure should be high ????
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Quote:
Originally Posted by drzamzam View Post
But isn't pulse pressure = the difference between systolic and diastolic pressure. In case of aortic stenosis, systolic is high (more pressure is required to case a change in volume) and diastolic is low (less blood volume in aorta) thus pulse pressure should be high ????
Yes pulse pressure = SP-DP.

So in aortic stenosis end systolic volume increases and systolic pressure in left ventricle increases.

You are getting confused with systolic pressure of left ventricle with systolic pressure of cardiac out.

Pulse pressure= systolic pressure(coutput)- diastolic pressure(tpr)

In aortic stenosis systolic pressure across left ventricle increases and so along valve area--> but due to stenosis it cannot produce much output--> so decreasa cardiac output--> so decreased systolic pressure-->so difference in systolic and diastolic decreases so narow pulse pressure.
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Quote:
Originally Posted by confident View Post

You are getting confused with systolic pressure of left ventricle with systolic pressure of cardiac out.

Pulse pressure= systolic pressure(coutput)- diastolic pressure(tpr)

In aortic stenosis systolic pressure across left ventricle increases and so along valve area--> but due to stenosis it cannot produce much output--> so decreasa cardiac output--> so decreased systolic pressure-->so difference in systolic and diastolic decreases so narow pulse pressure.
Many thanks, I know Im asking a lot of questions but I really appreciate ur help !!!
Can you please tell me the difference between systolic pressure of left ventricle with systolic pressure of cardiac out. And what did u mean by Systolic pressure (Coutput) diastolic (TPR) ???
thanks in advance
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Quote:
Originally Posted by drzamzam View Post
Many thanks, I know Im asking a lot of questions but I really appreciate ur help !!!
Can you please tell me the difference between systolic pressure of left ventricle with systolic pressure of cardiac out. And what did u mean by Systolic pressure (Coutput) diastolic (TPR) ???
thanks in advance
No problem at all.....

Systolic pressure of left ventricle means pressure generated in left ventricle during systole( i,e with in heart chambers)

When you calculate pulse pressure you use formula pulse pressure= systolic pressure- diastolic pressure where cardiac output represents systolic pressure and total peripheral resistence represent diastolic pressure.

So decrease in coutput decrease systolic pressure thats what i meant by systolic pressure of cardiac output( i assumed that you know the concept and i wrote like this to simplify actually there is no pressure of cardiac output i just meant to differentiate two different systolic pressure caused by inside left ventricle chamber and cardiac output)
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Help another designation

Quote:
Originally Posted by confident View Post
No problem at all.....

Systolic pressure of left ventricle means pressure generated in left ventricle during systole( i,e with in heart chambers)

When you calculate pulse pressure you use formula pulse pressure= systolic pressure- diastolic pressure where cardiac output represents systolic pressure and total peripheral resistence represent diastolic pressure.

So decrease in coutput decrease systolic pressure thats what i meant by systolic pressure of cardiac output( i assumed that you know the concept and i wrote like this to simplify actually there is no pressure of cardiac output i just meant to differentiate two different systolic pressure caused by inside left ventricle chamber and cardiac output)
So systolic pressure in pulse pressure formula is just a designation (or another naming or term used) for CO ???
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Quote:
Originally Posted by drzamzam View Post
So systolic pressure in pulse pressure formula is just a designation (or another naming or term used) for CO ???

CO= SV*HR

PP= SYSTOLIC PRESSURE-DIASTOLIC PRESSURE

Both are different but interlinkingly increase or decrease in one effects other.

As stroke volume or HR increases it increases CO. So this does not mean SV is another term for CO.

We know from physiology that as CO decreases in aortic vessel it generates low systolic pressure in vessel.


Goodluck.
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