Aortic and PUlmonary Valve disease Flashcards Preview

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Flashcards in Aortic and PUlmonary Valve disease Deck (55):
1

aortic root

aortic leaflet
outflow of LV

2

three major pathologies of aortic stenosis

1) bicuspid = raphe = fusion btwn 2 cusps

2) calcific = restrict movement of valve

3) rheumatic = commissures fused with calcification

3

what happens before aortic stenosis

aortic sclerosis

4

define aortic sclerosis

thickening of valve but not significant degradation

5

progression of aortic stenosis

1) calcium deposit

2) sclerosis

3) mild fibrosis

4) severe stenosis

5) restrict motion of leaflet and incr velocity

6

hemodynamics in aortic stenosis

higher velocity through aortic stenotic valve

7

patients at risk of AS

aortic sclerosis
bicuspid valve

8

physical exam in aortic stenosis

1) palpable systolic thrill on chest

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

9

auscultation of aortic stenosis

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

narrowing between valve closure with inspiration

10

Indications for aortic valve replacement

1) symptomatic

2) asymptomatic + low LVEF
asymptomatic + high gradient

3) symptomatc

11

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

atherosclerosis

12

when does tricuspid valve most commonly become stenotic

60's, 70's, 80's

13

why does tricuspid valve become stenotic

calcium deposits in valve cusps

NOT FUSION OF COMMISSURES

14

what is a rare cause of aortic stenosis in developed countries

rheumtatic fever

15

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

mitral valve also affected

16

what is mainstay for diagnosiing aortic valve disease?

echo + Doppler interrogation of aortic valve

17

what is recommended treatment for symptomatic severe aortic stenosis

valve replacement (must have strong indications)

18

what is outlook for patients receiving aortic valve replacmeent

75% death within 3 yrs of sx onset

19

what are cardinal symptoms of severe aortic stenosis

1) angina

2) syncope

3) SOB and heart failure

20

what is most common congentical cardiac malformation?

BICUSPID AORTIC VALVE

21

how do bicuspid aortic valves form?

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

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

--> COMPLEX DEVELOPMENTAL

22

after development, what is bicuspid aortic valve associated with?

1) aortic dilation of prox ascending aorta due to abnormalities in aortic media

2) aneurysms

3) dissection

23

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

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

24

what is cellular effects of bicuspid aortic valve

1) decr microfibrillar elements

2) smooth muscle detachment

3) MMP release

4) matrix disruption

5) cell death

6) loss support, elasticity

25

what is inheritance of bicuspid aortic valve

autosomal dominant + reduced penetrance

26

which gender is more likely affected with bicuspid aortic valve hereditary

males 4:1

ECHO SCREEN 1ST DEGR RELATIVES

27

valvular complications of bicuspid aortic valve

1) aortic stenosis

2) aortic insufficency

3) endocarditis

28

describe aortic stenosis with bicuspid aortic valve

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

29

describe aortic insufficency in bicuspid aortic valve

1) cusp prolapse

30

which patient population gets endocarditis with bicuspid aortic valve

young and with AI

31

vascular complications of bicuspid aortic valve

1) aortic dilation

2) aneurysm form

3) aortic dissection

4) coarctation

5) PDA

6) coronary disease

32

classifications of bicupsid aortic valve

1) after sabet

2) after roberts

33

auscultation in bicuspid aortic valve

a

34

HOW DO YOU manage bicuspid aortic valve

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

35

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

pts with mild-to-mod valvular dysfunction

normal LV dimensions/function

36

other form of aortic stenosis

1) subvalvular disease

2) hypertrophic obstructive cardiomyopathy

37

describe subvalvular disease

1) thin membrane

2) thick fibromuscular ridge

3) diffuse tunnel obstruction

38

describe hypertrophic obstructive cardiomyopathy

1) abnromal mitral valve attachments

2) accessory endocardial cusion tissue

39

valvular diseases with aortic regurgitation

1) Rheumatic

2) degenerative

3) endocarditis

4) congenital (bicuspid/quadricuspid)

40

diseases of aorta with aortic regurg

1) dissection

2) marfan's

3) atherosclerosis

4) annuloartic ectasia

5) syphilis

6) ankylosing spondyltiis

7) osteogenesis imperfecta

41

heart sound with aortic regurg

diastolic murmur

starts at S2--> descrendo (high pitch)

42

signs of aortic regurg

Corrigan's pulse

Rapid forceful carotid upstroke followed by rapid decline

43

signs of aortic regurg

Quincke's pulse

Diastolic blanching in nail bed when slightly compressed

44

signs of aortic regurg

de Musset's sign

bobbing of head

45

signs of aortic regurg

Durozie's sign

Systolic and diastolic femoral bruits when compressed with stethoscope

46

signs of aortic regurg

Hill's sign

Systolic BP in legs > 30 mmHg than in arms

47

grading of aortic regurg

use echocardiogram to measure jet return from aorta back to LV

48

indications for AR

severe AR with symptoms

49

a

a

50

a

a

51

a

a

52

most common patient group with pulmonic stenosis

children

but can come in during adolescence/adulthood

53

new main treatment for pulmonic valve stenosis

percutaenous balloon valvuloplaty

EXCEPT FOR PEOPLE WITH DYSPLASTIC VALVES

54

old treatment for pulmonic valve stenosis

surgical valvotomy

55

Difference btwn mechanical and bioprosthesis

1) mechanical = need warfarin + long lasting

2) in older 70-80 y/o patients because more likely to degenerate