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DMST 283 ECHO 2 > Aortic Regurgitation > Flashcards

Aortic Regurgitation Flashcards

1
Q

What is Aortic insufficiency?

A

Aortic regurgitation

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2
Q

What happens during aortic insufficiency?

A

Blood moves backwards through the AV from aorta to the left ventricle throughout diastole

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3
Q

What are the 3 groups of mechanisms that can cause AI?

A
  1. Cuspal abnormalities
  2. Aortic root dilatation
  3. Loss of commissures support
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4
Q

Cuspal abnormalities include what?

A
  1. Congenital abnormalities
  2. Rheumatic aortic valve disease
  3. Aortic valve prolapse
  4. Infective endocarditis
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5
Q

What is Cuspal abnormalities in general?

A

Any congenital disorder or disease process that affects the AV cusps

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6
Q

What are things we should look for in terms of congenital abnormalities?

A
  1. Bicuspid AV
  2. Quadricuspid AV
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7
Q

Wha this Rheumatic AV disease?

A

Cusp tissue is infiltrated wit fibrous tissue causing them to shorten and retract

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8
Q

What can no longer happen during rheumatic AV disease?

A

Cups can no longer come together to coapt

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9
Q

Rheumatic AV disease is usually associated with what?

A

Some degree of Aortic stenosis

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10
Q

How common is aortic valve prolapse?

A

Rare

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11
Q

What is Aortic valve prolapse defined as?

A

Cusp leaflet tips displaced below the valve ring during diastole

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12
Q

Aortic valve prolapse maybe due to what?

A
  1. Myxomatosis degeneration of the valve or due to rheumatic heart disease
  2. Occur secondary to aortic root dilation or trauma
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13
Q

What is aortic bacterial endocarditis?

A

Vegetation destroys the AV

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14
Q

What may Aortic bacterial endocarditis may cause?

A

Perforation of the cusp

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15
Q

What does aortic root dilation prevent?

A

Normal leaflet coapt action during diastole which leads to AR

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16
Q

What are causes of Aortic dilation?

A
  1. HTN
  2. Atherosclerosis
  3. Connective tissue disorders
  4. Bicuspid AV
  5. Sinus of valsalva aneurysm
  6. Idiopathic dilation
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17
Q

Loss of commissures support may occur with what?

A
  1. Ventricular septal defects
  2. Aortic dissections
  3. Aortic trauma
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18
Q

What are some causes of severe AR?

A
  1. Trauma
  2. Infective endocarditis
  3. Aortic dissection
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19
Q

Acute- severe AI causes an increase in what?

A

Filling pressures
Mainly LV end diastolic pressure

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20
Q

What is this hole in the AV caused by?

A

Annular dilation

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21
Q

Why is Acute severe AI mainly in the LVEDP?

A

During diastole we have
1. Normal inflow plus
2. Regurgitation volume leaking back into the LV

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22
Q

During LVEDP Acute means what in terms of acute severe AI?

A

No time for LV to stretch, therefore LVEDP increases dramatically

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23
Q

What is chronic severe AI pressure?

A

Filling pressure normal and slightly elevated

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24
Q

In terms of chronic severe AI regurgitation volume causes what?

A

LV chamber volume to increase over time due to stretching

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25
Q

Chronic severe AI returning eventually leads to what?

A
  1. Increase in forward volume through AV
  2. Volume entering LV has increased form the AI (Chamber has dilated to try to accommodate it)
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26
Q

What is Chronic severe overload usually associated with?

A

Volume overload

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27
Q

Once the LV is dilated in chronic AI what happens?

A
  1. This leads to near normal filling pressures
  2. LV MAss will increase (eccentric)
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28
Q

In terms of chronic AI over time the LV may start to do what?

A

Start to fail at which time the LVEDP will increase

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29
Q

In terms of chronic AI Pressure, overload leads to what?

A

Volume overload

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30
Q

What are signs and symptoms of AI?

A
  1. CHF symptoms
  2. Occasional chest pain with chronic severe AI
  3. Pulmonary edema with acute AI
  4. Auscualtion
  5. ECG (LVH 80%, ventricular arrhythmias)
  6. Cardiomegaly
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31
Q

Why would someone have occasion chest pain during chronic severe AI?

A

Increase in LV mass decreases myocardial perfusion causing ischemia

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32
Q

What is a complication of increased LV and LA size and pressure overload for AI?

A
  1. Leads to pulmonary congestion leading to pulmonary edema, right heart failure, systemic venous congestion and edema
  2. Edema
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33
Q

What are some medications for AI?

A
  1. Beta blocker
  2. ACE inhibitors
34
Q

What are some lifestyle treatments for AI?

A

Avoidance of heavy physical exertion

35
Q

What are some surgical treatments for AI?

A
  1. Indicated for significant, chronic AI
  2. AV repair
  3. AV replacement
36
Q

What are three ways to treat AI?

A
  1. Medication
  2. Lifestyle
  3. Surgical
37
Q

What is the role of echo if AI?

A
  1. Determine etiology
  2. Assess LV size and function
  3. Measure aortic dimensions
  4. Estimate severity of AI
38
Q

How do we determine a quadricuspid AV?

A
  1. Made in PSAX
  2. Look for an X or +
39
Q

How common is a quad AV?

A

Rare bicuspid is more common

40
Q

How do we determine bicuspid AV?

A
  1. Eccentric closure line in PLAX
  2. Small mass (vegetation) on the AV in the PLAX zoom
    both pathologies lead to AI
41
Q

What does bicuspid AV Jets look like?

A

Usually eccentric (off to one side)

42
Q

With a Bicuspid AV the asc AO may be what

A

Dilated

43
Q

In terms of a bicuspid AV, AV severity presents how?

A

Progressive

44
Q

How does bicuspid AV AI affects younger and older patients?

A
  1. Younger patients have mild AI
  2. As the patient gets older it gets worse as the root dilates
  3. Leads to chronic, severe AI
45
Q

Infective endocarditis is a common cause of what?

A

Acute severer AI

46
Q

What is seen with infective endocarditis?

A

Hyper mobile mass on the underside of the AV (LV side)

47
Q

What does infective endocarditis cause?

A

AI by infection destroying one or more of the cusps

48
Q

What is aortic root dilation in terms of AI?

A

Any disease that dilates the aortic root will not allow the cusps to close tightly leading to AI

49
Q

What is aortic dissection with AI?

A

A dissection in the proximal portion of the aorta will cause some AI

50
Q

What is the VSD in terms of AI

A
  1. Membranous VSD are located just on the LV side of the AV
  2. This can affect the support structure of the aortic rood leading to AI
51
Q

Label the image

A
52
Q

Label the image

A
53
Q

What colour doppler assessments will we do for AI?

A
  1. Jet height ratio
  2. Jet area ratio
  3. Vena contracta width
54
Q

What are spectral doppler assessments we do?

A
  1. AI jet intensity
  2. Flow reversals
  3. AI P 1/2 t
  4. Regurgitation volume (RV)
  5. Regurgitation fraction (RF)
  6. Effective regurgitation orifice area (EROA)
55
Q

What structures do we assess for AI?

A
  1. LV size
  2. Wall thickness
  3. LV function
56
Q

How do we measure Jet height? (Which windows do we use?)

A
  1. Measure in PLAX
  2. Measure in LVOT
57
Q

What is Jet height/ LVOT ratio numbers?

A

Mild <25% (1/4)
Severe > 65% (2/3)

58
Q

Do we use the jet height/ LVOT ratio on eccentric AI?

A

No

59
Q

Should we zoom for jet height measurements?

A

Yes

60
Q

What is the eyeball method values?

A
61
Q

How do we measure vena contracta width?

A

Measure at the narrowest point using zoome

62
Q

What does Vena contracta width look like? What are the values?

A
63
Q

In terms of AI jet intensity, density (brightness) of the AI jet is proportional to what?

A

Number of RBCs moving in unison

64
Q

The brighter the AI signal, the more RBCs are travelling where?

A

Backward through the AV in diastole

65
Q

What is the difference between bright signal and faint signal for AI?

A
  1. Bright = more significant
  2. Faint = trivial or mild AI
66
Q

What kind of regurgitation doe each of these images have?

A

Mild on the left and significant on the right

67
Q

How do we find flow reversal in the descending AO? (What window)

A

Form the SSN window

68
Q

When looking for flow reversal in the Desc aort what do we look for in the SSN window?

A
  1. Look for retrograde flow in Desc Ao
  2. PW Desc AO
69
Q

If we see flow reveral in the ABD Ao, this indicates what?

A

Severe AI and should be holo-diastolic

70
Q

How do we get AI pressure 1/2 time?

A
  1. Use CW
  2. Align to the AI jet direction
  3. Measure the deceleration rate
  4. Usually best from apical window
71
Q

In terms of a AI pressure half time, what does a steep slope and a gentle slope mean?

A
  1. Steep = severe
  2. Gentle = mild
72
Q

What are some values to remember in terms of AI pressure half time?

A
73
Q

What is the continuity equation?

A
74
Q

What is something we need to remember for the continuity equation?

A

The SV of regurgitating valve will be higher than the SV on a non-regurgitation (normal) valve

75
Q

What is AI reg volume numbers for mild and severe?

A
  1. Mild <30ml
  2. Severe >60ml
76
Q

What is regurgitation fraction?

A

Percentage of blood leaking back across valve

77
Q

What is the formula for regurgitation fraction?

A
78
Q

What are the regurg fraction values for mild and severe?

A
79
Q

What does EROA stand for and what is the formula for it?

A
  1. Effective regurgitation orifice area
  2. EROA = RVol/VTI ai jet
80
Q

How do we do a quantitative AI assessment?

A

PISA

81
Q

Do we do quantitative AI assessments in Alberta?

A

No

82
Q
A

DMST 283 ECHO 2 (14 decks)

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