Aortic/Pulmonic Valve Disease Flashcards Preview

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Flashcards in Aortic/Pulmonic Valve Disease Deck (23):

What's up with bicuspid AV disease?

• Your tricuspid valve should have 3 sinuses of valsalva and 3 cusps
• If you have 2 cusps your valve doesn't work so well
• Can be b/c two cusps fused (funcitonal) or can be b/c you only had 2 cusps ever


Why might aortic dilatation happen in bisupid AV patients?

• Change in the ECM and altered structure of aorta


Why are you concerned about bicuspid AV?

• Aortic senosis in 75% of cases
• Aortic insufficienty in 25% of cases
• Increased risk of endocarditis
• AD inheritance and pretty common so you will likely see this


What are the vascular complications often seen in bicuspid aortic valve?

• Aortic dilation
• Aneurysim formation
• Aortic dissection


What are the vascular complications often seen in bicuspid aortic valve?

• Aortic dilation
• Aneurysim formation
• Aortic dissection


If you find Biscupid aortic valve in a patient, what should be the next steps?

• Monitor. Get echos done and make sure the problems associated with the disease are not occuring (or catch them early)
• If aortic size is over 5.5cm go to surgery


What's up with calcific aortic stenosis?

• Older people will get a buildup of calcium in blood and deposit it on valve
• Main problem is increased pressure LV has to pump against


Why might rheumatic aortic stenosis cause a problem?

• Leads to fusion of the cusps and a smaller hole that blood has to be pumped through


What symptoms might a patient with aortic stenosis present with?

• Dyspnea on exertion
○ HF b/c of elevated LV pressures
• Exertional lightheadedness or syncope
○ Decreased CO b/c of LV outflow obstruction
• Exertional angina


What's the classic physical exam finding in a patient with aortic stenosis?

• Harsh, crescendo-decrescendo systolic murmur heard best over RUSB
○ Ratiation to carotids
• If there is bicuspid AV, you will hear systolic ejection click


Besides physical exam what methods are best for diagnosing aortic stenosis?

• Echocardiogram (nice to see AND it's non-invasive
• catheter (better for making hemodynamic measurements and getting an area on the opening)


What is medical therapy in AS really designed to do?

• Treat comorbid conditions, not really treat the stenosis itself
* also, you have to be slow and cautious with new treatments because the heart has adapted already so it may not be able to handle the drugs (hypotensive in ACEI use is the example)
• Gold standard of AS treatement is surgery


The classic marker in the physical exam of severe aortic stenosis is what (murmur)?

• Harsh systolic murmur at RUSB, which radiates to carotids
• Longer, LATE PEAKING murmurs are associated with more severe disease


With aortic insufficiency, what is the progression of disease?

• Left ventricle dilates because of incrased EDV (blood from aorta is coming back into LV)
• Systolic dysfuction
• Heart failure


What can cause aortic insufficiency?

• Bicuspid AV
• Calcific disease
• Endocarditis
• Reheumatic disease
• Dissection - aortic
• Marfans - aortic
• Aneurysm-dilation - aortic


What are some physical exam findings centered around the nature of the pulse you might see in aortic insufficiency?

• Water hammer pulse
○ Rapidly swelling and falling arterial pulse
• deMusset's sign
○ Head bob with each heart beat
• Quincke's pluses
○ Capillary pulsations in fingertips
• Muellers sign
○ Systolic pulsations of uvular
• Corrigan's pulse
○ Rapid forceful upstroke in carotid, rapid decline


On auscultation, what findings will suggest Aortic insufficiency?

• Early diastolic murmur
○ Left sternal border
○ Severity increase increases duration of murmur through diastole
• Austin-flint murmur
○ Heard at apex
○ Secondary to turbulent diastolic blood flow across the mitral valve
• Systolic murmur may occur due to increased blood flow across aortic valve, mimics AS sounds


Chronic Aortic insufficiency will eventually result in what?

• Ventricular dilation (left)
• Systolic dysfunction
• Congestive heart failure


What is the medical treatment for Aortic insufficiency?

• If heart failure is present, treat the heart failure
○ ACEI, ARB, Beta blockers, diuretics
• Always monitor the patient by Physical exam and echo to see if things are getting to the point of surgery


What does a pt with pulmonic stenosis present with?

• After a long asymptomatic stage they present with
• RVH, then RV systolic failure
• Exertional dyspnea
• Chest pain
• Syncope
• Peripheral edema


What are you listening for in the physical exam for Pulmonic stenosis?

• Systolic ejection murmur loudest at the left upper sternal border
○ Longer and late peaking correlates with disease severity
• Radiates to the back
• Split S2
○ More split, more severe disease
• Right sided S4 may be present if RVH


What is the monitoring recommended for a patient with pulmonic stenosis?

frequent EKGs to monitor for RVH


Where are you going to auscultate evidence of pulmonic insufficiency?

• Early diastolic murmur best heard over the left 2nd and 3rd intercostal spaces
• May increase on inspiration
• Grahm-steel murmur
○ PI murmur with PH
○ High pitched and blowing