Aortic and Pulmonary Valve Disease

Question 1

Fusion of 2 of the cusps is called?

Answer 1

Raphae

Question 2

Systole vs Diastole in valves

Answer 2

Systole = open
Diastole = closed

Question 3

Explain calcific vs Rheumatic disease of valves

Answer 3

Rheumatic - fuse first and then calcify

Calcific - calcifications first then fuses

Question 4

Normally what happens to A2 and P2 when breathing? What happens with Aortic stenosis?

Answer 4

A2 before P2, with small separation upon inspiration.

With Stenosis, A2 comes after P2 upon inspiration

Question 5

The more severe the stenosis, the ____ the murmur will peak

Answer 5

The later the murmur will peak

Question 6

What happens when aortic stenosis occurs hemodynamically?

Answer 6

When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body.
Extra work limits the amount of blood it can pump and may weaken your heart muscle.

Question 7

Stages of stenosis

Answer 7

A: at risk of AS - aortic sclerosis, bicuspid valve
B Progressive AS - mild/moderate AS
C: Asymptomatic Severe AS
D: Symptomatic Severe AS

Question 8

When the aortic valve is affected by rheumatic heart disease, what other valve is usually affected?

Answer 8

Mitral

Question 9

3 cardinal symptoms of stenosis:

Answer 9

1. Angina
2. Syncope
3. SOB

Question 10

When is AVR indicated usually?

Answer 10

Valve replacement is recommended for individuals with symptomatic severe aortic stenosis. Such patients have a dire outlook, with 75% dying within 3 years of symptom onset

Question 11

How is aortic stenosis diagnosed?

Answer 11

The echocardiogram with Doppler interrogation of the aortic valve serves as the mainstay of diagnosis

Question 12

What is the main mechanism and when in life do you get AV stenosis

Answer 12

The tricuspid aortic valves become stenotic in the sixth, seventh, and eighth decades of life, mainly caused by calcium deposits in the valve cusps and not by fusion of the commissures

Question 13

What is the most common congenital malformation of a valve? Who is most affected?

Answer 13

Bicuspid Aortic Valve; men affected 4:1, but only 1-2% of population have it

Question 14

Signs of Aortic Regurgitation

Answer 14

Corrigan’s pulse: Rapid forceful carotid upstroke followed by rapid decline
Quincke’s pulse: Diastolic blanching in nail bed when slightly compressed
de Musset’s sign: Bobbing of head
Durozie’z sign: Systolic and diastolic femoral bruits when compressed with stethoscope
Hill’s sign: Systolic BP in legs > 30 mmHg than in arms

Question 15

What’s the preferred treatment of pulmonic stenosis right now? Who can’t have it?

Answer 15

Percutaneous balloon valvuloplasty has largely replaced surgical valvotomy except in patients with dysplastic valves.

Question 16

Aortic insufficiency (AI), also known as ________

Answer 16

aortic regurgitation (AR):
sws  is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.

Question 17

aortic stenosis sounds

Answer 17

1. ejection click ( just precedes the murmur)
   - opening snap
   best heard at the lower left sternal border and the apex, and, thus, appear to be “split”. The ejection sound, caused by the impact of left ventricular outflow against the partially fused aortic valve leaflets
2. S4

Question 18

most common congenital cardiac defect

Answer 18

Bicuspid aortic valve disease

Question 19

mainstay of diagnosis of aortic and pulmonic valve disease.

Answer 19

echocardiogram with Doppler interrogation

- Valve replacement is recommended for individuals with symptomatic severe aortic stenosis due to  dire outlook, with 75% dying within 3 years of symptom onset.
- Have mechanical problem, need mechanical fix

Question 20

If pt has severe aortic regurg (AR) and is symptomatic:

what is the treatment?

Answer 20

Get AVR (pretty straight forward)

note: If pt is asymptomatic and has LVEF>50% may monitor or get AVR.