Aortic Valve Disease

Question 1

What is Aortic Regurgitation (AR)?

Answer 1

Backflow of blood through the aortic valve during ventricular diastole

Aortic Regurgitation is also known as AR.

Question 2

During which phase of the cardiac cycle does Aortic Regurgitation occur?

Answer 2

Ventricular diastole

Ventricular diastole is the phase when the heart’s ventricles relax and fill with blood.

Question 3

What are the types of congenital native valve etiology related to leaflets?

Answer 3

Bicuspid AV, Quadracuspid, Unicuspid

These conditions refer to the number of leaflets in the aortic valve.

Question 4

What congenital condition is associated with aortic dilation?

Answer 4

Annuloaortic ectasia

This condition is linked to connective tissue diseases such as Marfan syndrome, Loeys-Dietz syndrome, and Ehlers-Danlos syndrome.

Question 5

Which connective tissue diseases are associated with annuloaortic ectasia?

Answer 5

Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome

These syndromes can lead to dilation of the aorta.

Question 6

What are the acquired causes of native valve etiology related to leaflets?

Answer 6

Senile thickening, Infective endocarditis, Rheumatic disease, Radiation-induced valvulopathy, Carcinoid

These conditions can affect the structure and function of heart valves.

Question 7

What systemic condition can lead to acquired aortic dilation?

Answer 7

Systemic hypertension

This is caused by increased pressure or resistance in the blood vessels.

Question 8

Which inflammatory condition is associated with acquired aortic dilation?

Answer 8

Ankylosing spondylitis

This is a chronic inflammatory arthritis that can affect the aorta.

Question 9

What type of aortitis can lead to acquired aortic dilation?

Answer 9

Syphilitic aortitis

This is caused by the infection of syphilis affecting the aorta.

Question 10

What are some causes of aortic dilation related to trauma?

Answer 10

Aortic dissection, Trauma

These conditions can lead to structural changes in the aorta.

Question 11

True or False: Rheumatic disease is a common acquired cause of native valve etiology.

Answer 11

False

Rheumatic disease is considered rare in this context.

Question 12

What is a central jet murmur?

Answer 12

High-pitched, blowing, decrescendo diastolic murmur

You do not hear trace or mild aortic regurgitation (AR) with this murmur.

Question 13

What characterizes an Austin Flint murmur?

Answer 13

Low-pitched diastolic ‘rumble’ at the apex associated with severe eccentric aortic regurgitation

This murmur is distinct from other types due to its association with severe AR.

Question 14

What does CW Doppler measure in the assessment of AR?

Answer 14

-Density of jet
-mean pressure gradient
-velocity of jet(blood flowing through AoV

CW Doppler refers to Continuous Wave Doppler.

Question 15

What is flow convergence in AR assessment?

Answer 15

A qualitative method used to evaluate the severity of the regurgitation.

Question 16

What is assessed using PW Doppler in AR evaluation?

Answer 16

Flow reversal in abdominal Ao, proximal descending aorta, and aortic valve

Ao stands for Aorta.

Question 17

What is a semi-quantitative method for assessing AR?

Answer 17

-Vena Contracta Width (VCW)
-flow convergence

VCW is a measurement used to evaluate the severity of AR.

Question 18

What is the role of beta blockers in medical treatment?

Answer 18

Slows heart rate and increases preload

Beta blockers are commonly used in various cardiovascular conditions to manage heart rate and improve cardiac output.

Question 19

Name three types of medications used in the medical treatment of heart conditions.

Answer 19

• ACE inhibitors
• Antiarrhythmic agents
• Diuretics

These medications serve different purposes in managing heart conditions, including blood pressure regulation and fluid management.

Question 20

What should be avoided to prevent worsening of heart conditions?

Answer 20

Heavy physical exertion

Engaging in intense physical activity can exacerbate symptoms and lead to increased severity of the condition.

Question 21

Under what conditions is surgical replacement indicated?

Answer 21

• Symptomatic
• LV EF < 50%
• Hemodynamic instability (acute)
• Heart size increased at end-diastole > 7.5 cm; end-systole > 5.5 cm (measured by echo)

These criteria help determine the need for surgical intervention in patients with significant heart dysfunction.

Question 22

What are the two types of AR jet direction?

Answer 22

• Central jet
• Eccentric jet

A central jet points directly toward the mitral valve, while an eccentric jet points toward the septum.

Question 23

What is the significance of Vena Contracta (VC) in assessing AR?

Answer 23

It measures how wide the jet is in the PLAX view

Vena contracta is the narrowest part of the jet and indicates the severity of regurgitation.

Question 24

What Vena Contracta width indicates mild Aortic Regurgitation?

Answer 24

< 0.30

A wider Vena Contracta suggests more severe regurgitation.

Question 25

Fill in the blank: The _______ measures how far the jet extends into the left ventricle.

Answer 25

Flow Convergence ## Footnote This measurement helps assess the severity of the regurgitation.

Question 26

What is the width criterion for VC in Mild AR?

Answer 26

< 0.3 cm

Question 27

What is the maximum width of the Central Jet for Mild AR?

Answer 27

< 25% of LVOT

Question 28

What type of flow convergence is expected in Mild AR?

Answer 28

Small or no flow convergence

Question 29

What is the PHT threshold for Mild AR?

Answer 29

> 500 ms

Question 30

What is a flail valve?

Answer 30

A condition in which a valve does not close properly, leading to significant regurgitation.

Question 31

What is the VC width criteria for severe AR?

Answer 31

VC width > 0.6 cm

Question 32

What is the central jet width in severe AR?

Answer 32

Central Jet width ≥ 65% of LVOT

Question 33

What is the PHT threshold for severe AR?

Answer 33

PHT < 200 ms

Question 34

What does prominent holodiastolic flow reversal in the descending aorta indicate?

Answer 34

It is a sign of severe aortic regurgitation.

Question 35

What is the expected left ventricle condition in severe AR?

Answer 35

Enlarged LV with normal function.

Question 36

What is one effect of M-Mode findings in significant, highly eccentric AR?

Answer 36

Creates 'fluttering' on the leaflet ## Footnote Fluttering is an observable phenomenon indicative of leaflet motion.

Question 37

What does jet density indicate in the context of CW Doppler evaluation of AR?

Answer 37

The more bright/complete the signal indicates more significant AR ## Footnote AR stands for aortic regurgitation.

Question 38

What is pressure half-time (PHT) in relation to AR?

Answer 38

Half the time it takes for the AR slope to meet the zero Doppler baseline ## Footnote PHT is a useful measure in assessing the severity of aortic regurgitation.

Question 39

What does a steeper AR slope indicate?

Answer 39

The more severe the AR ## Footnote A steeper slope suggests a faster decline in pressure, indicating greater severity.

Question 40

What is holo-diastolic flow reversal in the proximal descending thoracic aorta indicative of?

Answer 40

Severe aortic regurgitation (AR) ## Footnote Holo-diastolic flow reversal is a significant finding in Doppler assessments for diagnosing severe AR.

Question 41

What is the significance of an increase in LVOT velocity greater than 1.5 m/sec?

Answer 41

It indicates severe aortic regurgitation (AR) ## Footnote LVOT stands for Left Ventricular Outflow Tract.

Question 42

What does an increase in LVOT VTI greater than 40 cm suggest?

Answer 42

Severe aortic regurgitation (AR) ## Footnote VTI stands for Velocity Time Integral, which is a measure used in echocardiography.