Aortic and PUlmonary Valve disease

Question 1

aortic root

Answer 1

aortic leaflet

outflow of LV

Question 2

three major pathologies of aortic stenosis

Answer 2

1) bicuspid = raphe = fusion btwn 2 cusps
2) calcific = restrict movement of valve
3) rheumatic = commissures fused with calcification

Question 3

what happens before aortic stenosis

Answer 3

aortic sclerosis

Question 4

define aortic sclerosis

Answer 4

thickening of valve but not significant degradation

Question 5

progression of aortic stenosis

Answer 5

1) calcium deposit
2) sclerosis
3) mild fibrosis
4) severe stenosis
5) restrict motion of leaflet and incr velocity

Question 6

hemodynamics in aortic stenosis

Answer 6

higher velocity through aortic stenotic valve

Question 7

patients at risk of AS

Answer 7

aortic sclerosis

bicuspid valve

Question 8

physical exam in aortic stenosis

Answer 8

1) palpable systolic thrill on chest

2) palpable thrill at neck due to delay blood flow to neck

Question 9

auscultation of aortic stenosis

Answer 9

closing of aortic valve later than pulmonic vlave due to delayed ejection from LV

narrowing between valve closure with inspiration

Question 10

Indications for aortic valve replacement

Answer 10

1) symptomatic

2) asymptomatic + low LVEF
asymptomatic + high gradient

3) symptomatc

Question 11

What is now believed mechanism by which healthy tricuspid aortic valve becomes stenotic?

Answer 11

atherosclerosis

Question 12

when does tricuspid valve most commonly become stenotic

Answer 12

60’s, 70’s, 80’s

Question 13

why does tricuspid valve become stenotic

Answer 13

calcium deposits in valve cusps

NOT FUSION OF COMMISSURES

Question 14

what is a rare cause of aortic stenosis in developed countries

Answer 14

rheumtatic fever

Question 15

if aortic valve is affected by rheumatic heart disease what else is also affected?

Answer 15

mitral valve also affected

Question 16

what is mainstay for diagnosiing aortic valve disease?

Answer 16

echo + Doppler interrogation of aortic valve

Question 17

what is recommended treatment for symptomatic severe aortic stenosis

Answer 17

valve replacement (must have strong indications)

Question 18

what is outlook for patients receiving aortic valve replacmeent

Answer 18

75% death within 3 yrs of sx onset

Question 19

what are cardinal symptoms of severe aortic stenosis

Answer 19

1) angina
2) syncope
3) SOB and heart failure

Question 20

what is most common congentical cardiac malformation?

Answer 20

BICUSPID AORTIC VALVE

Question 21

how do bicuspid aortic valves form?

Answer 21

due to abnromal aortic cusp formation during valvulogenesis –> forms raphe

–> cusps fuse to form bigger cusp (smaller than 2 indiv cusps)

–> COMPLEX DEVELOPMENTAL

Question 22

after development, what is bicuspid aortic valve associated with?

Answer 22

1) aortic dilation of prox ascending aorta due to abnormalities in aortic media
2) aneurysms
3) dissection

Question 23

despite developmental effect, what should bicuspid aortic valve be considered as?

Answer 23

disease of entire aortic root (affects elastic lamina of aortic media)

Question 24

what is cellular effects of bicuspid aortic valve

Answer 24

1) decr microfibrillar elements
2) smooth muscle detachment
3) MMP release
4) matrix disruption
5) cell death
6) loss support, elasticity

Question 25

what is inheritance of bicuspid aortic valve

Answer 25

autosomal dominant + reduced penetrance

Question 26

which gender is more likely affected with bicuspid aortic valve hereditary

Answer 26

males 4:1 ECHO SCREEN 1ST DEGR RELATIVES

Question 27

valvular complications of bicuspid aortic valve

Answer 27

1) aortic stenosis 2) aortic insufficency 3) endocarditis

Question 28

describe aortic stenosis with bicuspid aortic valve

Answer 28

1) most common 2) age 15-65 3) rapid in asymmetric valves/Ant-post valves

Question 29

describe aortic insufficency in bicuspid aortic valve

Answer 29

1) cusp prolapse

Question 30

which patient population gets endocarditis with bicuspid aortic valve

Answer 30

young and with AI

Question 31

vascular complications of bicuspid aortic valve

Answer 31

1) aortic dilation 2) aneurysm form 3) aortic dissection 4) coarctation 5) PDA 6) coronary disease

Question 32

classifications of bicupsid aortic valve

Answer 32

1) after sabet | 2) after roberts

Question 33

auscultation in bicuspid aortic valve

Answer 33

a

Question 34

HOW DO YOU manage bicuspid aortic valve

Answer 34

1) serial assay with echo to get functional status of valve and measure

Question 35

which group of bicuspid aortic valve patients should be monitored consistently with

Answer 35

pts with mild-to-mod valvular dysfunction normal LV dimensions/function

Question 36

other form of aortic stenosis

Answer 36

1) subvalvular disease | 2) hypertrophic obstructive cardiomyopathy

Question 37

describe subvalvular disease

Answer 37

1) thin membrane 2) thick fibromuscular ridge 3) diffuse tunnel obstruction

Question 38

describe hypertrophic obstructive cardiomyopathy

Answer 38

1) abnromal mitral valve attachments | 2) accessory endocardial cusion tissue

Question 39

valvular diseases with aortic regurgitation

Answer 39

1) Rheumatic 2) degenerative 3) endocarditis 4) congenital (bicuspid/quadricuspid)

Question 40

diseases of aorta with aortic regurg

Answer 40

1) dissection 2) marfan's 3) atherosclerosis 4) annuloartic ectasia 5) syphilis 6) ankylosing spondyltiis 7) osteogenesis imperfecta

Question 41

heart sound with aortic regurg

Answer 41

diastolic murmur starts at S2--> descrendo (high pitch)

Question 42

signs of aortic regurg Corrigan's pulse

Answer 42

Rapid forceful carotid upstroke followed by rapid decline

Question 43

signs of aortic regurg Quincke's pulse

Answer 43

Diastolic blanching in nail bed when slightly compressed

Question 44

signs of aortic regurg de Musset's sign

Answer 44

bobbing of head

Question 45

signs of aortic regurg Durozie's sign

Answer 45

Systolic and diastolic femoral bruits when compressed with stethoscope

Question 46

signs of aortic regurg Hill's sign

Answer 46

Systolic BP in legs > 30 mmHg than in arms

Question 47

grading of aortic regurg

Answer 47

use echocardiogram to measure jet return from aorta back to LV

Question 48

indications for AR

Answer 48

severe AR with symptoms

Question 49

a

Answer 49

a

Question 50

a

Answer 50

a

Question 51

a

Answer 51

a

Question 52

most common patient group with pulmonic stenosis

Answer 52

children but can come in during adolescence/adulthood

Question 53

new main treatment for pulmonic valve stenosis

Answer 53

percutaenous balloon valvuloplaty EXCEPT FOR PEOPLE WITH DYSPLASTIC VALVES

Question 54

old treatment for pulmonic valve stenosis

Answer 54

surgical valvotomy

Question 55

Difference btwn mechanical and bioprosthesis

Answer 55

1) mechanical = need warfarin + long lasting | 2) in older 70-80 y/o patients because more likely to degenerate