Aortic Valve Disease Flashcards Preview

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Flashcards in Aortic Valve Disease Deck (41):
1

Level of evidence A

multiple RCTs, multiple populations evaluated

2

Level of Evidence B

single randomized trial or nonrandomized studies

3

Level of evidence C

expert opinion, case studies, or "standard of care"

4

in biscusp AV, which leaflets are most commonly fused?

R + L

5

what is the most common valvular lesion in USA?

AS

6

what percent of population has bicusp AV?

1-2%

7

what is almost always associated with rheumatic AS?

MV involvement

8

what is the appearance of a bicusp AV on PLAX of echo?

dome shaped

9

do most bicusp AV become stenotic?

no

10

what is the key to diagnosing rheumatic AS?

MV involvement

11

in a young patient with bicusp AV and HTN, what should you watch out for?

coarctation and dissection

12

besides murmur, what doyou auscultate for SEVERE AS?

loss of A2, late ejection

13

Cardiac output/ Sq rt Gradient= ?

AVA

14

Mod AS: Jet velocity, Mean gradient, AVA

Jet velocity, Mean gradient, AVA
3-4m/s, 25-40mmHg, 1-1.5cm2

15

Stage of AS if at risk with sclerosis or bicuspid/congenital

A (At risk)

16

Stage of AS if mild to mod AS +/- diastolic dysfxn, calcification or rheumatic changes
No sxs

B (Progressive AS)

17

Stage of AS if no sxs, severe calcification, severe AS on echo , LVH, diastolic dysfxn

C1 (asymptomatic severe AS)

18

Test for Stage C1 AS

Stress

19

Stage of AS if severe AS, LV<50%, no sxs

C2

20

Stage of AS if severe w/ sxs, LVH, diastolic dysfxn, +/- PH

D1

21

Protocol for f/u echocardiograms in asymptomatic mild, moderate and severe AS

Q5y, 3y, annually

22

In AS, how much is jet velocity expected to increase per year?

0.3 m/s

23

In AS, how much is gradient expected to increase per year?

7mm Hg

24

In AS, how much is AVA expected to decrease per year?

0.1cm2

25

What stage is severe AS with low EF and LFLG?

D2

26

What stage is severe AS with preserved EF and paradoxical LFLG?

D3

27

What to look for on dobutamine stress to rule in true AS LFLG (not pseudo stenosis )?

Inc in gradient with dobutamine

28

Which trial showed no clinical, echo, CT benefit to statin in AS?

Saltire

29

Can you do a dobutamine study onto differentiate pseudo-AS vs real AS on a pt with normal EF?

No

30

Usually which side of a valve with regurgitation is a vegetation on?

Downstream

31

What stage of AI is severe AR without sxs and normal LVEF?

C1

32

What stage of AI is severe AR, no sxs, LVEF<50% or 50mm?

C2

33

What stage of AI is severe AR, with sxs, LV dilation, +/- LV dysfxn?

D

34

Finding in proximal Ao for severe AI?

Flow reversal

35

Vena contracta defining severe AR

>.6 cm

36

ERO defining severe AR

> . cm2

37

Medical Treatment for acute AI

Nipride (ideal)
Hydralazine
No IABP

38

How often do you get echo in patients with severe AI or root root dilatation?

Yearly

39

What is main factor that decides operative mortality for AI?

LV fxn

40

AI indications for Sx

Sxs (I)
LVEF < 50%
LV Dil: ESD> 50mm or EDD> 65mm

41

Hakai eqn in cath lab

AVA= CO/ sq rt P2P