CVPR 04-02-14 10-11am Aortic and Pulmonary Valve Disease - Salcedo Flashcards Preview

â–º Med Misc 16 > CVPR 04-02-14 10-11am Aortic and Pulmonary Valve Disease - Salcedo > Flashcards

Flashcards in CVPR 04-02-14 10-11am Aortic and Pulmonary Valve Disease - Salcedo Deck (25):
1

Aortic valve anatomy

Aortic root just behind pulmonary artery; Aortic valve in center of heart, behind pulmonic valve & in front of mitral & tricuspid valves…. Three cusps/flaps (left & right where left & right coronary arteriess exit + N?)

2

Aortic Stenosis – mechanism

The mechanism by which a healthy tricuspid aortic valve becomes stenotic is believed to be similar to that of atherosclerosis….. become stenotic in 6th-8th decades of life, mainly caused by calcium deposits in the valve cusps and NOT by fusion of the commissures.

3

Aortic stenosis & Rheumatic fever

Rheumatic fever is very rarely the cause of aortic stenosis in developed countries; when it is, mitral valve is almost always affected as well.

4

Dx of Aortic Stenosis

1. Listen to the patient….. 2. Echocardiogram w/ Doppler interrogation of aortic valve = mainstay of Dx

5

Therapy for Aortic Stenosis

Valve replacement is recommended for individuals w/SYMPTOMATIC SEVERE aortic stenosis (dire prognosis)… may be mechanical or bioprosthetic replacement (can’t repair) – choice depends on age of pt, others [bioprosthesis wears out, so not recommended in young; however, its advantage is that you don’t need warfarin as you would w/a mechanical replacement]

6

Cardinal Symptoms of Severe Aortic Stenosis

Angina, Syncope & Shortness of Breath (HF)….. as soon as symptoms occurs, marked downhill curve in survival

7

Aortic stenosis – cardiac findings

Often cardiac hypertrophy, b/c left ventricle must work harder to get blood out into the aorta

8

Pathophysiology of calcific aortic stenosis

Same risk factors as CAD/atherosclerosis – lipids, HTN, Male gender, Smoking, Diabetes, etc…. proceeds through a process similar to atherosclerosis (cholesterol deposits get calcified)

9

Bernoulli Equation in Echocardiograms

How we measure velocity of red cells … from that estimate pressure gradients through aortic valve (when gradient = ~20, call aortic stenosis) … can also calculate aortic valve area

10

Bicuspid Aortic Valve disease (BAV) – pathophysiology

Two of the three cusps are fused (usually left & right leaflets) = bicuspid instead of tricuspid… Some problem/deficiency with elastic fibers in laminae of aortic media

11

Bicuspid Aortic Valve disease (BAV) – associations

Most common congenital cardiac defect (1-2% of babies)… Can be found in isolation, but often associated w/dilation of proximal ascending aorta secondary to abnormalities of the aortic media.

12

Bicuspid Aortic Valve disease (BAV) – associated problems

After its development, BAV is associated with aortic stenosis, aortic dilation, aneurysms, and dissection… Thus, BAVs should be considered a disease of the entire aortic root.

13

Hereditary Bicuspid Aortic Valve Disease (BAV)

Familial clustering = autosomal dominant inheritance w/reduced penetrance….. Males are affected 4:1….. Echocardiographic screening of first-degree relatives is warranted.

14

Valvular Complications of BAV:

1. Aortic stenosis (AS age 15-65= BAV; AS more rapid in asymetric valves or antero-posterior)….. 2. Aortic Insufficiency (Cusp prolapsed, etc) ….. 3. Predisposition for Endocarditis, esp. in young pts & pts w/AI

15

Vascular Complications of BAV:

1. Aortic dilation….. 2. Aneurysm formation….. 3. Aortic dissection (Coarctaction, PDA, Coronary anomalies)

16

Risk factors for Adverse Cardiac Events in Adutls w/BAV disease

Age 30yrs; Moderate/severe aortic insufficiency; Moderate/severe aortic stenosis

17

Management of BAV

Mild-to-moderate valvular dysfunction & normal LV dimensions/function = Regular echocardiography of aortic valve to evaluate its functional state & measure aortic diameter, chamber dimensions, & ventricular function

18

Other Forms of Aortic Stenosis - Subvalvular disease

1. Thin membrane (the most common lesion), 2. Thick fibromuscular ridge, 3. Diffuse tunnel-like obstruction, 4. Hypertrophic Obstructive Cardiomyopathy, 5. Abnormal mitral valve attachments, and 6. Accessory endocardial cushion tissue

19

Aortic regurgitation – causes of valvular disease

Valvular disease (Rheumatic, Degenerative, Endocarditis, Congenital - Bicuspid/Quadricuspid)

20

Aortic regurgitation – causes of disease of the aorta

Disease of the aorta (Dissection, Marfan’s, Atherosclerosis, Annulo-aortic ectasia, Syphilis, Ankylosing spondilitis, Osteogenesis imperfect)

21

Aortic regurgitation – sound

High pitched, like huff (like mom when she eat hot food…NOT like low pitched blowing out)

22

Signs of aortic regurgitation

Corrigan’s pulse (rapid forceful carotid upstroke followed by rapid decline)… Quincke’s pulse (diastolic blanching in nail bed when slightly compressed)… de Musset’s sign (bobbing of head)… Durozie’s sign (systolic & diastolic femoral bruits when compressed w/stethoscope)… Hill’s sign (systolic BP in legs >30mmHg than in arms)

23

Therapy for aortic insufficiency/regurgitation

Severe AI = surgery (valve replacement)

24

Pulmonic stenosis - when IDed

A common forms of congenital heart disease…. Most pts are children, though pts w/congenital pulmonic stenosis may come to medical attention during adolescence or adulthood

25

Pulmonic stenosis – management

Recently, percutaneous balloon valvuloplasty has largely replaced surgical valvotomy except in pts w/ dysplastic valves

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