Complications & Prognosis

AORTIC STENOSIS

Prognosis

Adults without symptoms
- excellent prognosis
- normal life expectancy but should receive
- advised to receive antibiotic prevention – aortic valve infection

Adults with symptoms
a) Mild – usually leads a normal life, but some may progress to severe disease
b) Moderate – most end up with coronary artery disease within 10 years
c) Severe – once symptoms occur, death within 2-4 years if untreated, mortality rates of 75%

- Disease curable with surgery
- Moderate & severe stenosis eventually treated with surgery (progressive disease)
- eg : valve replacement (10 year survival rate = 75%)

- Post-surgical risks
a) Arrhythmias - sudden death
b) Blood clots – stroke
c) New valve not working & need to be replaced.

Complications

—Arrhythmias
—Endocarditis
—Left ventricular hypertrophy
—Sudden death
—Congestive heart failure
—Exacerbation of coronary artery disease
—Pulmonary oedema

a) Left ventricular hypertrophy
- Aortic valve narrowed
- Left ventricle has to work harder to pump sufficient blood to aorta and rest of the body - HYPERTROPHY
- Eventually weakens, leading to
i) Heart failure
ii) Arrythmias
iii) Cardiac arrest
iv) Angina

b) Endocarditis
- Narrowed aortic valve more prone to infection
- Turbulence damages endothelium
- Bacteria & inflammatory cells adhere & grow, forming an infected vegetation
- Increased risk of bacteria entering bloodstream

c) Cardiac failure
- Lack of sufficient blood flow to meet body’s needs.
- Causes : MI, IHD, hypertension
- Leads to : Pulmonary oedema (L), peripheral oedema (R)


ANGINA

Prognosis

- Stable angina is a marker of underlying CHD
- People with angina are 2–5 times more likely to develop other manifestations of CHD than people who do not have angina.
- People with angina had higher mortality than people with no history of coronary artery disease at baseline


Features that indicate a poorer prognosis :
Ø more-severe symptoms
Ø Male
Ø abnormal resting ECG
Ø previous MI
Ø left ventricular dysfunction
Ø easily provoked or widespread coronary ischaemia on stress testing
Ø significant stenosis of all three major coronary arteries or the left main coronary artery.


Complications
- If untreated, chronic stable angina --> unstable angina (untreated)
a) Severe arrythmias
b) Sudden cardiac death