Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PNS/Cardiology > Aortic Valve Disease > Flashcards

Aortic Valve Disease Flashcards

1
Q

What are the 3 main causes/etiologies of aortic stenosis?

A

Congenital valve malformation i.e. Bicuspid aortic valve
Rheumatic
“Senile” calcific disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens to the valve to cause stenosis in bicuspid aortic valve?

A

Wear and tear on the valve causes calcium to build up and inhibit opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to the valve to cause stenosis in rheumatic disease?

A

Fuses the comissures - causing scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to the valve to cause stenosis in “senile” calcific disease?

A

Valve was normal but wear and tear caused build up of calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What factors does aortic stenosis have in common with coronary atherosclerosis?

A

Both more common in men, elderly, and patient with hypercholesterolemia
Derived in part from inflammatory process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which etiology does aortic stenosis before the age of 60 indicate?

A

Bicuspid valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which etiology does aortic stenosis after the age of 60 indicate?

A

Probably “senile” calcific valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens to the LV when there is aortic stenosis?

A

Aortic stenosis –> increased pressure in LV –> LV concentric hypertrophy –> increased LV stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What symptoms make up the clinical triad of aortic stenosis?

A

Congestive heart failure
Angina Pectoris
Syncope (effort related)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are physical diagnosis signs of aortic stenosis?

A

Murmur
Ejection click
Carotid artery pulsation
S4 sound (atrial gallop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the murmur heard in aortic stenosis

A

Crescendo-decrescendo between S1 and S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the ejection click heard in aortic stenosis

A

High frequency sound hear just after S1

Occurs at the time of aortic valve opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the carotid artery pulsation felt in aortic stenosis

A

Because of obstruction, upstroke of carotid may be slowed and can feel a slow rise in carotid on palpation

If stroke volume is low (later in disease), can palpate flow turbulence, felt as a vibration

Pulsus parvus et tardus (small and late pulse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the S4 sound heard in aortic stenosis

A

Tap right before S1 (presystolic)

Reflects a stiff left ventricle that you can feel at apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What etiology of aortic stenosis does the ejection click suggest?

A

Bicuspid valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a good sentence to remember that S4 goes with aortic stenosis?

A

“A stiff wall”

Where S4 is the “A”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can you have the patient do to be able to hear the S4 better?

A

Have patient do sit ups (exercise) or have them squeeze your finger
This will acutely increase BP

18
Q

What are clues of aortic stenosis that can be seen on echo?

A

Anatomy, detect calcification, evaluate opening of valve

Quantitate pressure gradient across the AV and calculate aortic valve area

19
Q

Which patients should be given antibiotic prophylaxis before dental work?

A

Patients with:
Prosthetic valves
Previous endocarditis
Specific congenital heart disease

20
Q

What are the two types of replacement valves?

A

Mechanical

Tissue

21
Q

What type of valve should younger patients receive?

A

Mechanical

22
Q

What type of valve should older patients receive?

A

Tissue

23
Q

What are the advantages and disadvantages of mechanical valves?

A

Advantage - long lasting

Disadvantage - need anticoagulation

24
Q

What are the advantages and disadvantages of tissue valves?

A

Advantage - do not need anticoagulation

Disadvantage - degenerates over time

25
Q

What are possible complications of prosthetic heart valves?

A 
Thromboembolism
Bleeding (secondary to anticoagulation)
Valve dysfunction
Valve regurgitation
Endocarditis
26
Q

What other aortic issue is bicuspid aortic valve associated with?

A

Aortic dilations, aneurysms and dissections

Due to accelerated degeneration process that results in structural weakness of wall

27
Q

What are the two major etiologies that lead to aortic regurgitation?

A

Abnormalities of valve leaflet

Dilatation of aortic root

28
Q

What happens to the LV when there is chronicaortic regurgitation?

A

Aortic valve leaflets cannot coapt –> backward runoff –> volume overload of the LV –> LV dilatation –> increased LV diastolic volume –> wall stress –> formation of new sarcomeres “eccentric hypertrophy”

29
Q

What occurs to the systemic diastolic pressure and systemic systolic pressure in chronic aortic regurgitation?

A

Decreased systemic diastolic pressure - aortic valve cannot maintain pressure in aorta in diastole

Increased systemic systolic pressure - large volume of blood goes backwards, increasing the SV from LV into aorta

Causes WIDE PULSE PRESSURE

30
Q

What is concentric hypertrophy and is it seen in aortic stenosis or aortic regurgitation?

A

Pressure overload leads to fattening of myocytes and sarcomeres added in parallel, causing LV hypertrophy
Aortic stenosis

31
Q

What is eccentric hypertrophy and is it seen in aortic stenosis or aortic regurgitation?

A

Volume overload leads to stretching of the myocytes and sarcomeres added in series, causing LV dilation
Aortic regurgitation

32
Q

What are symptoms of aortic regurgitation?

A

Congestive heart failure
Occasionally angina
Wide pulse pressure

33
Q

What are physical signs of aortic regurgitation?

A

Wide pulse pressure (i.e. 200/40)
Cardiomegaly (LV dilated)
Murmur

34
Q

Describe the murmur heard in aortic regurgitation?

A

Early diastolic high-pitched blowing murmur (heard after S2)

35
Q

In what location and what position (of the patient) is the aortic regurgitation murmur best heard?

A 
Location = sternal border
Position = leaning forward
36
Q

What are some of the peripheral findings caused by the wide pulse pressure in aortic regurgitation?

A

Synchronous head bob (de Musset’s sign)
Uvula pulsing
Capillaries of finger
Carotid double beating

37
Q

What are clues of aortic regurgitation that can be seen on echo?

A

Aortic regurgitation flow

Determine LV function

38
Q

What are the causes of acute aortic regurgitation?

A

Secondary to trauma, endocarditis, aortic dissection

Severe = surgical emergency

39
Q

Why is acute aortic regurgitation so dangerous?

A

LV does not have time to dilate and acute increase in LV pressure can be abruptly reflected back to the lungs, causing acute pulmonary edema and death

40
Q

How do the physical findings of acute aortic regurgitation differ from those of chronic aortic regurgitation?

A

Signs of chronic AR are often absent in acute AR

  • NO cardiomegaly (LV hasn’t had time to dilate)
  • NO wide pulse pressure
  • NO long diastolic blowing murmur
41
Q

Why is there no widened pulse pressure in acute aortic regurgitation?

A

Regurgitant volume into a non-dilated LV will cause LV diastolic pressure to rise
Diastolic pressure in aorta can only drop as low as diastolic pressure in LV - so diastolic pressure in aorta will not be low
LV cannot respond with increased stroke volume - so systolic pressure in aorta may not be elevated

Thus, wide pulse pressure is gone

42
Q

Why is there no murmur in acute aortic regurgitation?

A

Early equilibration of aortic and LV diastolic pressures shortens the murmur

PNS/Cardiology (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions