Valvular Heart Disease Flashcards
(76 cards)
doppler effect
as the police siren travels towards you, the frequency of the wave (pitch) appears to be higher than if it was stationary; as the siren travels away, the pitch appears to be lower.
change in pitch coming off the red cells
aliasing effect
when the velocity gets higher than the maximum velocity of blood flow away
seen as yellow
aliasing is an effect that causes different signals to become indistinguishable (or aliases of one another) when sampled
two most common valvular dzs
aortic stenosis and mitral regurg are the two most common valve disease
what should you be weary of in a pt with a bicuspid aorta
strong correlation between bicuspid valve and marfans syndrome which results in an aneurysm and rupture
if you hear that there is a bicupid valve in the aorta it is essential to do an echo to look for aneurysm
congenital types of aortic stenosis
” Bicuspid AS: MC of these (usually aortic valve is TRIcuspid)
“ Membranous subvalvar
“ Fused leaflets w/ doming
acquired degenerative types of aortic stenosis
Calcific AS: MC type you will see (RF: smoking, HTN, hyperlipidemia, DM - same RF as CAD)
Thickening & calcification develops @ 40-60yo
Hypertrophic subaortic: need an echocardiogram to distinguish
Rheumatic heart dz - caused by AS but affects mitral valve more than aortic
what % of the population has aortic stenosis
1% of population w/ M>W;
what is th epathophysiology of AS
aortic leaflets do not oppen and pressure in the LV increases in order to compensate with increased
results in muscle hyeprtrophy
early phase of aortic stenosis is seen as
diastolic dysfunction - heart stiffens/can’t relax, smaller chamber, reducing amnt of blood it can receive
late phased of AS
” Late Phase: systolic de-compensation - muscles can’t keep up w/ pressure
reduced EF
What type of pulse pressures do we see at the end stage of AS
b/c fall of ejection fraction; drop in amount of blood w/ each beat (difference in systol/diast pressures narrows) –> HYPOTENSION
classic triad of AS
Angina - d/t supply/demand mismatch when O2 demand of hypertrophied LV (& CAD) exceeds supply –>5yr survival AVR
CHF (diastolic & systolic) - bad if present –> 2yrs
Stokes-Adams attacks - exertional (pre-syncope + syncope); from reduced stroke volume & inadequate cerebral perfusion —>3yr AVR
why do we see angina in AS
NO obstruction in the coronary artery
the muscle needs a certain amt of oxygen and the coronary flow can not keep up
the result of this is exertion angina
most common presentation of AS
diastolic HF
LA pressure rises in order to fill LVE and backup leads to the lungs
Stokes-Adams attacks
(pre-syncope + syncope); from reduced stroke volume & inadequate cerebral perfusion –>3yr AVR
classically seen on the end of exertion when the peripheral vasculature is still dialated
person slows done and sympathetic tone falls
dip in blood pressure followed by a loss of consciousness
murmur we hear with AS
SYSTOLIC (harsh) ejection murmur
thrill (palpable murmur), over aortic area radiating to carotids; high enough energy sound can be felt
when do you hear the murmur with AS and what does it sound like
” Mid-systolic crescendo decrescendo mumur
which peaks later in systole w/ worsening severity
if you can feel the artery filling through your finger tips which could happen with AS what is this indicative of
Delayed arterial upstroke - reduction in stroke volume (hypertrophy = small chamber)
felt as a quick tap
pulse pressure with AS
” Narrow pulse pressure - brisk, weakened, delayed = pulsus parvis
what heart sounds do we hear with AS (describe S2)
” Soft S2 - leaflets snapping, S4 present if LVH
prognosis of AS
Long interval of compensation as stenosis develops; once sxs occur (angina, CHF, syncope) –> Pt is DOOMED!
When HF starts to occur í RAPID deterioration w/ poor prognosis at the point of decompensating, especially if patient is symptomatic
very
1 diagnostic test used for diagnosing AS
red cells have to really speed up and you can measure this velocity with an echocardiogram
o ↑ leaflet thickness (don’t open well) & echodensity w/ ↓ excursion on structural views
o ↑ systolic velocity of blood flow w/ reduced valve area on Doppler measured
o Aortic valve calcif
Echo aortic valve area and continuity equation
Echo aortic valve area: flow rate is constant regardless of where it’s measured.
things don’t pile up
place of cardiac catheterization
Cardiac catheterization primarily to evaluate coronaries b/c CAD frequently
can be used to measure the gradient across the valve
first measuring the pressure in the LV
210 in the LV
130 in the aorta
that is the gradient
you can calculate the valve area and the restriction
