Valvular heart disease - aortic

Question 1

What is the normal size of a aortic valve

Answer 1

3-4cm

Question 2

What size is a aortic stenosis

Answer 2

<1.5cm -2cm

Question 3

What is the aetiology of aortic stenosis

Answer 3

Degenerative - calcification = senile aortic stenosis
Rheumatic
Bicuspid stenosis

Question 4

What is the pathophysiology of rheumatic disease that results in aortic stenosis

Answer 4

Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

Question 5

What is the pathophysiology of degenerative that results in aortic stenosis

Answer 5

a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

Question 6

What is degenerative aortic stenosis linked to

Answer 6

athlersclerosis

Question 7

Why is the aortic valve the most likely to be affected degeneratively

Answer 7

As is the valve with the highest pressure of blood passing through it

Question 8

How does aortic stenosis result in myocardial ischaemia

Answer 8

Increased LV systolic pressure
leads to left ventricular hypertrophy
Increase left ventricular end-distolic pressure
left atrial pressure increases causing pulmonary hypertension
myocardial oxygen consumption increase due to myocyte size increasing
leading to higher susceptibility to Myocardial ischaemia
to cause Left Ventricular failure

Question 9

Whats is the cardinal symptoms of aortic stenosis

Answer 9

Chest pain (angina)
Syncope/Dizziness (exertional pre-syncope)
Breathlessness on exertion
Heart failure

Question 10

What does it means when symptoms become apparent in aortic stenosis

Answer 10

Need immediate treatment within a month as follows a long asymptomatic phase

Question 11

What is the clinical signs on examination of aortic stenosis

Answer 11

Pulse – small volume and slowly rising
JVP – prominent if RH failure present, low BP
Vigurous and sustained apex beat
RV heave
Auscultation:
Systolic murmur 
Normal first heart sound less audible second heart sound
Harsh ejection sound

Question 12

What is the investigations for aortic stenosis

Answer 12

ECG
CXR
Cardiac catheterisation
Echocardiography
Cardiac Magnetic Resonance

Question 13

What is show in an ECG of aortic stenosis

Answer 13

will show LVH – taller R waves or ST segment abnormalities

Question 14

What does a chest x ray show in aortic stenosis

Answer 14

Not conclusive unless aortic valve is calcified

Question 15

What is the purpose of Cardiac catheterisation

Answer 15

measure peak pressure in ventricle (below) and in aorta (above)

Question 16

What is the disadvantage to cardiac catheterisation

Answer 16

shows pressure at different moments in time so doesn’t really show stenosis severity.

very invasive and can lead to calcification breaking off and causing an emboli.

Question 17

Echocardiography is a less invasive but why is it a far more useful method of investigation

Answer 17

Demonstrates:
the cusp motility 
LV function 
Hypertrophy 
asses pressure gradient and aortic valve area 

therefore gives a better indication to severity

Question 18

Who is medical treatment limited to in those who develop atrial stenosis

Answer 18

Those who develop heart failure

Question 19

What is the medical treatment for atrial stenosis

Answer 19

Surgery: repair or replacement

Question 20

what is the two aetiologies of aortic regurgitation

Answer 20

Due to dysfunctional leaflets

Due to dilatation of aorta

Question 21

What is the aetiology of dysfunctional leaflets to cause aortic regurgitation

Answer 21

Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration

Question 22

What is the aetiology of the dilation of the aorta to cause aortic regurgitation

Answer 22

Connective tissue disorders

due to a pathological process e.g. hypertension

Question 23

What is the pathophysiology of aortic regurgitation that leads to left ventricular failure

Answer 23

The left ventricle commodities for both stroke volume and regurgitant volume
This increases left ventricular end-diastolic volume and left ventricular systolic pressure
Leading to LV hypertrophy
Greater size myocytes increase myocardial oxygen consumption
causing left ventricular failure

Question 24

What is the symptoms for chronic aortic regurgitation

Answer 24

Long asymptomatic phase

Exertional breathlesness

Question 25

what is the clinical signs of aortic regurgitation found in examination

Answer 25

Pulse – large volume and retracting/collapsing
(Corrigan sign)
Wide pulse pressure e.g. 170/40mmHg
Hyperdynamic, displaced apex beat
Auscultation:
DIASTOLIC MURMUR – very difficult to hear.
Comes between Second heart sound and first heart sound
Very faint and very early

Question 26

Why is the apex beat hyperdyanmic and displaced in AR

Answer 26

due to volume overloaded heart

Question 27

What position must the patient be sat in to hear the atrial regurgitation

Answer 27

patient must be sat up, leaning forward, and auscultate on held exertion

Question 28

What is the investigations for aortic regurgitation

Answer 28

ECG 
CXR 
Cardiac catheterisation
Echocardiography
Cardiac Magnetic Resonance

Question 29

Why is ST/T changes seen in an ECG on aortic regurgitation

Answer 29

due to Left Ventricular being strained

Question 30

What does the chest X-ray show in aortic regurgitation

Answer 30

cardiomegaly - abnormal enlargement of the heart

Question 31

What investigation is now obsolete in investigating aortic regurgitation

Answer 31

Cardiac catheterisation

Question 32

What does an echocardiography show in aortic regurgitation

Answer 32

demonstrates the AV cusp anatomy:
(thickening, prolapsing, number of cusps, vegetations)

LV function, dilation, hypertrophy

shows the prolapsing/backflow of blood

Question 33

What medical treatment is used to delay the timing for surgical intervention

Answer 33

Vasodilator therapy

Question 34

How is aortic stenosis differentiated from aortic sclerosis

Answer 34

Loss of aortic secondary heart sound

Question 35

On an ECG and ECHO what is the atrial ventricular pressure gradient that shows left ventricular hypertrophy

Answer 35

> 50mmHg