256 - Aortic Valve Disease Flashcards
What is the most dominant factor leading to valvular heart disease?
Rheumatic disease due to GAS pharyngitis
AS includes ___ of the patients with ____valvular disease; roughly ___ of the adult symptomatic patients are ____
1/4
Chronic
80%
Men
AS in adults occurs due to ____ of the ___, and occurs most commonly with ___ ,____, ___or ___
Degenerative calcification Aortic cusps Substrate of congenital disease (BAV) chronic deterioration Radiation previous rheumatic inflammation
Roughly ___ of people over ___demonstrate a certian degree of ____
30%
65
Aortic valve sclerosis
What is common to find together with rheumatic AS?
Mitral valve involvement
and aortic regurgitation
What is the most common congenital valvular disease? Who is more likely to suffer from it?
Bicuspid Aortic Valve (BAV)
1:2-4 M to W
What is the inheritance pattern of BAV?
Autosomal dominant with partial penetrance
Patients with BAV are in higher risk for ____ and ____
aneurisms
Dissections
What is Shone’s Complex?
BAV + left heart obstructing lesion
In most patients with AS ____ is usually in the normal range but won’t increase normally during ____
Resting CO
Exercise
AS is rarely clinically significant when it’s > than ___. Once symptomatic there is an
1 square cm
Indication for replacement
What are the 3 cardinal symptoms for AS?
- Dyspnea
- Angina pectoris
- Syncope
Why does dyspnea occur in AS?
Increase in lung intra capillary due to increase in left ventricle diastolic pressure, which is secondary to the lack of the left ventricle ability to relax
Why does Angina pectoris occur in AS?
Imbalance of oxygen demand and supply of the myocardia
Why does Syncope occur in AS?
Exertional syncope due to atrial pressure decrease
When will parvus et tardus occur in AS?
In late stages of the disease when the carotid pulse increase until reaching the pick
What can be palpated over the carotid artery (especially on the left side)?
Vibration or tremor
When auscultating to the heart of a patients with AS, what can we find?
- Double apical pulse (S4)- especially when lying on the your left side
- Systolic tremor on the base of the heart when leaning forward or in suprasternal notch
The murmur of AS is usually ___, appearing shortly after ___, rising until picking near the ___, ending before ___
Mid systolic
S1
Mid systole
Aortic valve closes
AS murmur is usually ___, and can be heard best at the ___. it sometimes radiate to the ___. The strength of the murmur is usually at least ___
Low pitched
Base of the heart (second intracoastal space on the right )
Carotids
3-4
Most severe AS ECG will show ___. Severe cases will show ____ and ___ in ___,___and___.
LVH ST depression T wave inversion Leads I aVL Left precordial leads
ECG in AS will not show ___ between the ECG severity and AS status.
Good correlation
What are the main findings in AS echo? (4)
Thickening
Calcifications
Reduce systolic opening of the valve
LVH
What is the surface area of AS (severe, medium, light)
<1.5 cm2
1-1.5 cm2
1.5-2 cm2
When using echo in order to assess AS, ____ is useful
Stress test
Which AS patients will benefit from PCI?
- Multivalvular disease
- Young asymptomatic patients with congenital uncalcified valve
- When suspecting the LV blockage to be above/below the valve
Most AS patients die on their ___ or ___ decade of life
Seventh
Eights
Most AS patients will show symptoms ____ before dying. They will show the following symptoms: ___, ___, ___.
4 years Angina pectoris (3 years) Syncope (3 years) Dyspnea (2 years) CHF (1-0.5 years)
Asymptomatic AS patients should be ___, using ___ to monitor the ___ and function
Followed up carefully
ECG
LV deterioration
There is an indication for surgery for patients with severe AS (____) who are ____, ____ (EF<50%), ____, and aneurisms in the aortic root/ascending aorta.
<1 cm
Symptomatic
Treated + LV systolic deterioration
BAV
Asymptomatic patients with ____ to ___ AS who are going through CABG, should also be going through ____
Medium
Severe
AVR
Relative indications for AVR include:
- Abnormalities on stress test
- Rapid progression of AS
- Very severe AS + low surgical risk
____ alone is not C/I for SAVR on AS patients
Age
What is ross procedure?
AVR with autologous pulmonary valve, and the placement of homograft instead of the pulmonary valve
____ is preferred on ____ and ____
PABV (percutaneous aortic balloon valvuloplasty)
Children
Young adults
What does TAVI stands for?
Trans Aortic Valve Implantation
Among ___ patients with ____ who are considered inoperable 1-2 year survival rates are ____ with TAVR than with medical therapy
Elderly
Severe AS
Significantly higher
1-2 years survival rates are essentially ____ for high surgical risk patients treated with TAVI or SAVR
Equal
TAVI is associated with an early hazard for ___ and a higher incident of _____ which is a risk factor for mortality in the next 2 years
Stroke
postprocedural paravalvur AR
What is Class I AVR indication?
Severe AS \+ 1. symptomatic stage or 2. asymptomatic stage but a. LVEF<50% b. Other cardiac surgery
