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Cardiovascular: Valvular Heart Disease > Aortic Stenosis > Flashcards

Aortic Stenosis Flashcards

1
Q

what is the most common cause of AS?

A

degenerative

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2
Q

what does degeneration do to the valve

A

calcifies it

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3
Q

degeneration is an inflammatory response involving ________and________-. The lesions contain ______ which calcify

A

is an inflammatory response involving macrophaes and t lymphocytes. The lesions contain lipoproteins which calcify

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4
Q

what is a more common cause of AS in the young?

A

congenital e.g. bicuspid valve

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5
Q

what are some other causes of AS?

A
  • rheumatic - This is not seen frequently anymore.
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6
Q

rheumatic HD tends to affect the _____ valve

A

mitral

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7
Q

what does rheumatic fever do to the valve

A

results in fusion, thickening and calcification of the valve

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8
Q

valvular aortic stenosis should be distinguished from other causes of obstruction to left ventricular emptying which include:

A
  • supravalvular obstruction
  • hypertrophic cardiomyopathy
  • subvalvular aortic stenosis
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9
Q

Obstructed left ventricular emptying leads to increased ___ ______r pressure and compensatory ___ _____
hyper- trophy. In turn, this results in relative _____ of the left ventricular myocardium, and consequent angina, ______ and _______ ventricular failure .

A

Obstructed left ventricular emptying leads to increased left ventricular pressure and compensatory left ventricular hyper- trophy. In turn, this results in relative ischaemia of the left ventricular myocardium, and consequent angina, arrhyth- mias and left ventricular failure.

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10
Q

what are the symptoms? SAD

A
  • syncope/dizziness
  • angina
  • dyspnoea
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11
Q

why do you get ischaemia?

A

because of LV hypertrophy- the heart has to work harder to get blood through the narrowed valve

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12
Q

_____ is an emergency in AS

A

syncope

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13
Q

what are the characteristics of the pulse in AS?

A

Low volume pulse - slow rising and weak

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14
Q

why is the pulse low volume ?

A

this is because AS means you can’t get blood from the main pump of the heart to the body

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15
Q

what is the apex beat like in AS?

A

Forceful displaced apex - due to LV hypertrophy

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16
Q

what is felt in the aortic area?

A

systolic thrill

17
Q

what sounds are heard in AS?

A
  • systolic ejection click,
  • S4 - caused by atrial contraction
  • reversed splitting of S2 on expiration
  • Ejection systolic murmur that can radiate to the carotids
18
Q

what happens to the S2?

A

it is quiet?

19
Q

why is S2 quiet?

A

because the valve is hardly moving so second sound is quieter

20
Q

what may be seen on ECG?

A
  • big QRS because of LVH
21
Q

If the patient is asymptomatic even with severe AS you ______ _____

A

If the patient is asymptomatic even with severe AS you don’t intervene

22
Q

what is done if the patient starts to experience symptoms?

A
  • Conventional valve replacement.
  • Trans catheter aortic valve replacement TAVI
  • Balloon Aortic valvotomy (BAV)
23
Q

Conventional valve replacement. This can be____or _____ and the operation is done via _____. The survival for this is _____ ___.

A

Conventional valve replacement. This can be tissue or mechanical and the operation is done via sternotomy. The survival for this is very good.

24
Q

under which circumstances are the valves not replaced?

A

if LV very dilated

25
Q

what are the pros of mechanical prosthetic valves?

A

they last a long time.

26
Q

what are the cons of mechanical prosthetic valves?

A

patients on warfarin because patients occasionally get valve thrombosis

27
Q

who tends to get mechanical prosthetic valves?

A

young people

28
Q

what are the pros of bio- prosthetic valves?

A

don’t need warfarin

29
Q

what are the cons of bio- prosthetic valves?

A

they only last 10 years or so and are reserved for older patients

30
Q

TAVI passed up the _____ artery.

The process involves the____ of the aortic valve

A

TAVI
passed up the femoral artery.
The process involves the crushing of the aortic valve

31
Q

balloon aortic valvotomy is usuallly for who?

A

patients who are very frail and elderly

Cardiovascular: Valvular Heart Disease (8 decks)

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