Aortic Insufficiency

Question 1

What causes Aortic Insufficiency?

Answer 1

1. Congenital
2. Calcific Degenerative Process
3. Rheumatic
4. Other Autoimmune causing inflammation
5. Myxomatous Valve Disease
6. Endocarditis
7. Idiopathic Aortic Root Dilation & Annulus Dilation

Question 2

Name the other autoimmune conditions that cause inflammation

Answer 2

1. lupus
2. rheumatoid arthritis
3. ankylosing spondylitis

Question 3

Describe the process of RHEUMATIC FEVER

Answer 3

• overactive antibodies inflame and scar connective tissue leading to fibrosis of leaflets and chordae or aortic root dilation

Question 4

What causes RHEUMATIC FEVER?

Answer 4

response to untreated strep

Question 5

Describe the process of MYXOMATOUS VALVE DISEASE

Answer 5

connective tissue disorder where cusps become thickened, elongated and redundant (fold onto themselves)

Question 6

What does MYXOMATOUS VALVE DISEASE lead too?

Answer 6

leads to AV prolapse

Question 7

What is the the MOST COMMON cause of Acute AI?

Answer 7

Endocarditis

Question 8

Describe the process of ENDOCARDITIS

Answer 8

infection of the endocardium that can lead to growth on leaflets OR destruction of valvular tissue

Question 9

What is the MOST COMMON cause of CHRONIC AI?

Answer 9

Idiopathic Aortic Root Dilation and Annulus Dilation

Question 10

Describe the process of MARFAN SYNDROME

Answer 10

inherited connective tissue disorder that affects eyes, skeleton and cause cause AR, AV, or AMVL to dilate

Question 11

Describe the process of CYSTIC MEDIAL NECROSIS

Answer 11

disorder of large arteries- focal degeneration of elastic tissue and muscle in the tunica media

Question 12

Marfans Syndrome is seen in what types of individuals?

Answer 12

very tall and thin individuals

Question 13

What are the symptoms of AI?

Answer 13

(decrease cardiac output)
DOE
dizziness
angina
fatigue
syncope

Question 14

What are signs of AI?

Answer 14

-signs of overload to pulmonary vasculature
- palpitations due to LVE
- wide pulse pressure

Question 15

What are the symptoms of OVERLOAD TO PULMONARY VASCULATURE

Answer 15

1. Dyspnea/DOE
2. Orthopnea
3. PND Paroxysmal Nocturnal Dyspnea
4. Cough
5. Rales or crackles
6. Sputum (blood tinged sputum = hemoptysis)

Question 16

What type of AUSCULTATION is heard with AI? And where is it heard?

Answer 16

blowing diastolic decrescendo murmur at upper RSB

Question 17

What kind of PALPITATION is heard and where is it done?

Answer 17

-pulsus bisferiens
-CCA
- only for significant AI

Question 18

What are the treatments for AI?

Answer 18

-AVR
-medications to prevent/ease failure
- prophylactic antibiotics

Question 19

When is AVR done?

Answer 19

• if patient is symptomatic
• if patient is asymptomatic and LVIDs > 5cm or EF below normal

Question 20

Define preload

Answer 20

volume that the LV needs to overcome in order to push the volume into the systemic circulation

Question 21

Define afterload

Answer 21

pressure that the LV needs to overcome in order to push the volume into the systemic circulation

Question 22

What type of medications are given to prevent/ease failure and what do they do?

Answer 22

1. vasodilators - decrease afterload
2. diuretics - decrease preload
3. nitrates - dilate coronary arteries
4. digoxin - increase force of LV contraction

Question 23

Name other Aortic Root Abnormalities

Answer 23

1. aortic aneurysm
2. dissection
3. coarctation

Question 24

What is COARCTATION

Answer 24

obstruction/narrowing of descending aorta and is congenital

Question 25

What conditions lead to Aortic Root Abnormalities

Answer 25

1. chronic hypertension 2. marfan syndrome 3. cystic medial necrosis

Question 26

What are the 8 2D FINDINGS for AI?

Answer 26

1. incomplete closure of cusps 2. anatomic abnormality of valve or root 3. hyperkinesis 4. LVE 5. eventual decrease of LVSF 6. possible fine fluttering & reversed dooming of AMVL 7. course flutter with AFib/Flutter if jet on AMVL 8. possible fibrotic contact lesion on septum or AMVL

Question 27

What are the M Mode FINDINGS for AI?

Answer 27

1. incomplete closure of cusps 2. IVS motion is exaggerated w/hyperkinesis 3. damping = increase in EPSS if jet directed on AMVL 4. LVE 5. premature closure of MV and opening of AV

Question 28

Pulsus Bisferiens means there are 2?

Answer 28

systolic peaks

Question 29

CHRONIC OR ACUTE FINDING: Possible raised fibrotic contact lesion on septum or AMVL

Answer 29

chronic AI

Question 30

CHRONIC OR ACUTE FINDING: Premature closure of MV and opening of AV on M Mode

Answer 30

acute severe AI

Question 31

Label chart for JET DIAMETER/LVOTd Modality View Location Measurement Timing

Answer 31

- Color Flow - PLAX/A5/A3 - LVOT jet - LVOTd & Jet Diameter - Diastole - 2D - PLAX/A5/A3 - LVOT - LVOTd - Diastole

Question 32

Label chart for AI PHT Modality View Location Measurement Timing

Answer 32

- CW - A5 - Ao closure or through AI jet - PHT - Diastole

Question 33

Norms for JET and LVOT diameter/area

Answer 33

< 25 % = mild AI 25-64 % = moderate AI > 64 % = severe AI

Question 34

Norms for color flow VENA CONTRACTA width

Answer 34

< . 3cm = mild .3 - .6cm = moderate > .6cm = severe

Question 35

Norms for PHT

Answer 35

> 500 msec = mild 200-500 msec = moderate < 200 = severe

Question 36

What are you measuring based on SV AT 2 INTRACARDIAC SITES?

Answer 36

RV RF EROAcm2

Question 37

What is the equation for RV

Answer 37

RV = LVOT SV (TSV) - MITRAL SV (FSV if no MR)

Question 38

What is the equation for RF

Answer 38

RF = RV / LVOT SV x 100

Question 39

Norms for RV?

Answer 39

<= 30 ml = mild 30 - <60 ml= moderate > 60ml = severe

Question 40

Norms for RF?

Answer 40

50% = severe

Question 41

Norms for EROAcm2?

Answer 41

< .10 = mild .10 - <.30 = moderate >.30 = severe

Question 42

What is the equation for EROAcm2?

Answer 42

EROA cm2 = RV /VTI RJ