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P&T Block 1 > L30 > Flashcards

L30 Flashcards

1
Q

What are 3 causes of aortic stenosis? What does each tell you about the patient?

A

Rheumatic - scarring
Congenital bicuspid valve (calcify over time) - young pts
Calcification - older pts

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2
Q

Pathophys of aortic stenosis

A

LV must pump harder to get through the valve - generate higher SYSTOLIC pressures to open it
Lead to LV hypertrophy
- ↑LV EDP
Can cause angina with ↑cardiac demand

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3
Q

What are the 3 clinical symptoms that aortic stenosis can present as?

A

HF - if this is your stenosis presentation, most likely to have worst outcome
Angina
Syncope = can’t ↑CO w/ exercise, associated with ventricular arrhythmia

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4
Q

What is the progression of aortic stenosis throughout life?

A

Long latent period
Until sudden onset of severe symptoms
Fast death

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5
Q

S2 heart sound

A

Aortic valve closes

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6
Q

S1 heart sound

A

Mitral valve closes

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7
Q

Sounds for aortic stenosis

A

Whooshing between S1-S2 = pressure gradient across the aortic valve
You’re hearing high velocity flow
JETS!!!

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8
Q

What sound specifically suggests a bicuspid valve

A

Ejection click right after S1 = bicupsid

+/1 whooshing of aortic stenosis depending on how calcified the valve is

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9
Q

What is the carotid artery pulsation for aortic stenosis?

A

Pulsus parvus et tardus

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10
Q

What does an S4 heart sound mean?

A

“Atrial gallop” // apical impulse
Still LV due hypertrophy from ↑LV P
The ↑P is being reflected onto atria -> LA contracting forcefully
(More common cause = HTN)

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11
Q

When do you hear S4 heart sound? What does it sound like?

A

Right before S1

“A stiff wall”

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12
Q

In total, what are the 4 things you could hear with severe stenosis?

A

Whooshing crescendo-decrescendo murmur
Ejection click
Soft S2
S4

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13
Q

What would you see on CXR for aortic stenosis?

A

LV prominence

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14
Q

What would you see on cardiac cath to determine aortic stenosis?

A

Pressure gradient between LV & aorta

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15
Q

Which pts get antibiotic prophylaxis? (pre-dental work)

A

Prosthetic valves
Previous endocarditis
Congenital heart disease

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16
Q

What is the pressure gradient and aortic valve area that indicates surgery?

A

Gradient > 50 mmHg

Valve area

17
Q

What are the advantages/disadvantages to mechanical valves for replacement?

A 
Adv = long lasting
Disadv = anti-coag forever
18
Q

What are the adv/disadv to tissue valves for replacement?

A 
Adv = no coag needed
Disadv = degenerates
19
Q

Which kind of aortic valve disease is associated with complications like aortic dilation, aneurysms and dissection?

A

Bicuspid AV valves

20
Q

What could be the reason bicuspid valve is also seen with aortic disease?

A

Fibrillin 1 deficiency - smooth muscle cell detach, cell death, loss of structure and elasticity

21
Q

2 causes of aortic regurgitation

A

Aortic valve abnormalities

Aortic root abnormalities - if this is the cause, operate immediately!

22
Q

Pathophys of aortic regurgitation

A

Aortic valve isn’t strong (opposite of stenosis)
Can’t hold the pressure gradient between aorta and LV
Leaking - pressure and volume in aorta leaks back into LV = ↑SV

23
Q

How does PP change with chronic aortic regurg?

A

PP wider b/c = ↓DP + ↑SP

24
Q

How does the structure of the LV change with chronic aortic regurg?

A

LV too much volume
LV dilation
↑LV EDV –> ↑wall stress –> new sarcomers form

25
Q

Describe LV hypertrophy in aortic regurg vs stenosis

A

Regurg = eccentric LVH (volume overload)
- Hypertrophy + dilated cavity
Stenosis = concentric (P overload)

26
Q

What is the net result of chronic aortic regurg?

A

CHF rEF + ↑diastolic pressure

27
Q

How are sarcomeres laid down in stenosis vs regurg

A 
Stenosis = in parallel = concentric hypertrophy
Regurg = in series = dilation + eccentric hypertrophy
28
Q

What does aortic regurg murmur sound like?

A

Blowing after S2
Longer the murmer the more severe the regurg
Hear 2 beats then whoosh
Vs. 1 beat whoosh beat 2 = stenosis

29
Q

Is aortic stenosis a systolic or diastolic murmur?

A

Systolic cres-decres

30
Q

Is aortic regurg a systolic or diastolic murmur?

A

Diastolic decres

31
Q

What is a clinical sign of high PP?

A

Head bob

32
Q

What do you see on doppler/echo for stenosis vs regurg?

A

Stenosis = see calcification/valve changes

Regurg - see the blood moving in opposite direction

33
Q

Major differences between acute and chronic aortic regurg - include cardiomegaly and PP

A 
Acute = still, small LV, ↑diastolic pressure, surg emergency b/c massive pulm edema
- NO cardiomegaly
- NO wide PP
- NO long blowing murmur 
Chronic = LV large, ↓DP ventricle
34
Q

What are key signs to make you think acute aortic regurg

A

Acute endocarditis

Aortic dissection

35
Q

What 2 drug classes do you want to use for aortic regurg

A

Diuretics - keep volume low

Lower afterload

P&T Block 1 (43 decks)

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