[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]”This patient has presented to A&E following a fall at home. Please examine their cardiovascular system and present your findings to the examiners.”[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191717″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][/vc_column][/vc_row]
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- Cardiovascular 0%
Aortic valve sclerosis is defined as calcification and thickening of the aortic valve without significantly obstructing ventricular outflow. 25%-30% adults over 65 and up to 40% adults over 75 have aortic sclerosis. Risk factors for aortic sclerosis include age, male gender, smoking, hypertension, hyperlipidaemia and diabetes. Aortic sclerosis can be detected as a systolic ejection murmur on physical examination. It is best confirmed by echocardiography. Aortic sclerosis should be considered as a potential marker of coronary disease, and is now considered upon the same spectrum as aortic stenosis.
The following criteria are proposed for the diagnosis of aortic valve sclerosis: irregular, non-uniform thickening of portions of the aortic valve leaflets or commissures, or both; thickened portions of the aortic valve with an appearance suggesting calcification (i.e. bright echoes); non-restricted or minimally restricted opening of the aortic cusps; and peak continuous wave Doppler velocity across the valve < 2 m/s.
It is suggested that aortic valve sclerosis severity should be graded as follows: grade 1 = increased echo density; grade 2 = thickening or calcific deposits ≥ 3 mm; and grade 3 = same as grade 2 with mildly restricted motion of aortic leaflets and pressure gradient < 16 mmHg across the aortic valve.
Aortic sclerosis without stenosis causes a mid-systolc ejection murmur, which can be heard above the right second intercostal space. The murmur is quiet and brief. Many patients with aortic sclerosis have no detectable murmur; such cases are usually identified as an incidental finding from echocardiography.
Both environmental and genetic factors relate to valve calcification. Initiated by endothelial disruption due to increased mechanical or decreased shear stress, aortic sclerosis shows subendothelial plaque-like lesions on the aortic side of the leaflet that extend to the adjacent fibrosa layer. This consists of intracellular and extracellular lipid accumulation [apolipoprotein (apo) E, apo (a), apo B]; inflammatory cells (foam cell macrophages, non-foam cells, and occasional T cells); extracellular matrix and angiotensin-converting enzyme (ACE); and fine, stippled mineralization associated with active production of osteopontin by a subset of lesion macrophages.
Although aortic sclerosis is common in elderly adults, those with aortic sclerosis are at higher risk of cardiovascular disease and special attention should be paid to cardiovascular risk factors. Lifestyle modifications to delay disease progress include stopping smoking, lowering blood pressure, blood glucose and LDL cholesterol. These measures will serve to reduce the risk of cardiovascular diseases.
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What is the cardiac murmur?CorrectIncorrect