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Flashcards in Aortic Regurg Deck (29)
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1
Q

Aortic Regurg: Etiology

A
  1. Primary cusp disease
  2. Dilated aortic annulus and root
  3. Loss of commissural support
  4. Prosthetic valve disease
2
Q

Aortic Regurg: Etiology–> Primary cusp disease

A
  1. Stenosis
  2. SBE
  3. Ankylosing
  4. Spondylitis
3
Q

Aortic Regurg: Etiology–> Dilated aortic annulus and root

A
  1. Marfan
  2. Aortitis
  3. HTN
  4. Aneurysm
4
Q

Aortic Regurg: Etiology–> Loss of commissural support

A
  1. TYrama
  2. Dissection
  3. Membranous VSD
5
Q

Which anomaly goes with aortic dissection?

A

Marfan syndrome

6
Q

Aortic Regurg: Pathophysiology

A
  1. Left ventricular volume overload
  2. Decreased ejection fraction with long standing regurg
  3. increased risk for endocarditis
7
Q

Aortic Regurg: Pathophysiology–> Left ventricular volume overload leads to?

A

LV dilation

8
Q

Aortic Regurg: Physical signs

A
  1. Bounding, bifid (bisferious) arterial pulse

2. Wide pulse pressure during BP readings

9
Q

Aortic Regurg: Physical signs–> Wide pulse pressure

A

Big difference between systolic and diastolic numbers during BP readings

10
Q

Aortic Regurg: Physical signs–> Murmur

A

High pitched diastolic “blowing” murmur left sternal border (LSB)

11
Q

Aortic Regurg: Physical signs–> Symptoms of?

A
  1. CHF
  2. DOE
  3. Angina
  4. Syncope
12
Q

What kind of murmur would you hear in a patient with a rupture of a sinus of valsalva aneurysm?

A

continuous (AO ( increased pressure) going to decreased pressure to RA so cont. RA pressure 5/6 Ao is always higher)

13
Q

Aortic Regurg: M-mode

A

May show diastolic fluttering of the mitral valve leaflets (mostly anterior) or interventricular septum

14
Q

Aortic Regurg: Echo

A
  1. MV “preclosure” with severe acute AR
  2. Diastolic fluttering or a lack of closure of the Ao leaflets
  3. Decreased excursion of the anterior MV leaflet
  4. LV dilation with increased LV mass
  5. AoV or root abnormalities may be present
  6. Pre-systolic opening of the Ao leafltes
  7. LV contractility may be hyper or hypodynamic (acute vs chronic)
15
Q

What is best for diagnosing aortic dissections?

A

TEE

16
Q

Chronic AR patients should have?

A

Serial echoes to follow changes in diastolic and systolic size

17
Q

What cuases MV preclosure?

A

An elevated LVEDP( end diastolic pressure)

18
Q

Where is normal MV closure?

A

MV closure is in the middle to the end of the QRS complex

19
Q

Aortic Regurg: Dopper–> Look for?

A
  1. diastolic turbulence in the LVOT

2. Diastolic flow reversal in the descending aorta (mod to severe)

20
Q

Aortic Regurg: Obtain the end diastolic gradient from CW Doppler to estimate?

A

The LVEDP (diastolic BP- end diastolic gradient)

21
Q

Aortic Regurg: Map the regurg area with?

A

Pulsed or color flow doppler

22
Q

Aortic Regurg: Try to determine the regurg area in?

A

LAX and SAX to estimate severity

23
Q

Aortic Regurg: JH/LVOT (ratio)
mild=
mod=
severe=

A
Mild= <25%
mod= 22-65%
severe= >65%
24
Q

Ao Pressure 1/2 time
Mild=
Mod=
Severe=

A
Mild= >500msec
Mod= 500-200msec
Severe= <200msec
25
Q

You can also estimate the LVEDP from?

A

AI Doppler traces

26
Q

LVEDP equation?

A

LVEDP= diastolic BP- end diastolic gradient

27
Q

The descending aorta has what kind of flow?

A

diastolic flow reversal (retrograde)

28
Q

Antegrade=

Retrograde=

A
Antegrade= normal flow direction
Retrograde= flow in opposite direction
29
Q

Mild aortic regurg has?

A

An incomplete spectral trace