256 - Aortic Valve Disease

Question 1

What is the most dominant factor leading to valvular heart disease?

Answer 1

Rheumatic disease due to GAS pharyngitis

Question 2

AS includes ___ of the patients with ____valvular disease; roughly ___ of the adult symptomatic patients are ____

Answer 2

1/4
Chronic
80%
Men

Question 3

AS in adults occurs due to ____ of the ___, and occurs most commonly with ___ ,____, ___or ___

Answer 3

Degenerative calcification 
Aortic cusps 
Substrate of congenital disease (BAV)
chronic deterioration
Radiation
previous rheumatic inflammation

Question 4

Roughly ___ of people over ___demonstrate a certian degree of ____

Answer 4

30%
65
Aortic valve sclerosis

Question 5

What is common to find together with rheumatic AS?

Answer 5

Mitral valve involvement

and aortic regurgitation

Question 6

What is the most common congenital valvular disease? Who is more likely to suffer from it?

Answer 6

Bicuspid Aortic Valve (BAV)

1:2-4 M to W

Question 7

What is the inheritance pattern of BAV?

Answer 7

Autosomal dominant with partial penetrance

Question 8

Patients with BAV are in higher risk for ____ and ____

Answer 8

aneurisms

Dissections

Question 9

What is Shone’s Complex?

Answer 9

BAV + left heart obstructing lesion

Question 10

In most patients with AS ____ is usually in the normal range but won’t increase normally during ____

Answer 10

Resting CO

Exercise

Question 11

AS is rarely clinically significant when it’s > than ___. Once symptomatic there is an

Answer 11

1 square cm

Indication for replacement

Question 12

What are the 3 cardinal symptoms for AS?

Answer 12

1. Dyspnea
2. Angina pectoris
3. Syncope

Question 13

Why does dyspnea occur in AS?

Answer 13

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

Question 14

Why does Angina pectoris occur in AS?

Answer 14

Imbalance of oxygen demand and supply of the myocardia

Question 15

Why does Syncope occur in AS?

Answer 15

Exertional syncope due to atrial pressure decrease

Question 16

When will parvus et tardus occur in AS?

Answer 16

In late stages of the disease when the carotid pulse increase until reaching the pick

Question 17

What can be palpated over the carotid artery (especially on the left side)?

Answer 17

Vibration or tremor

Question 18

When auscultating to the heart of a patients with AS, what can we find?

Answer 18

1. Double apical pulse (S4)- especially when lying on the your left side
2. Systolic tremor on the base of the heart when leaning forward or in suprasternal notch

Question 19

The murmur of AS is usually ___, appearing shortly after ___, rising until picking near the ___, ending before ___

Answer 19

Mid systolic
S1
Mid systole
Aortic valve closes

Question 20

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 ___

Answer 20

Low pitched
Base of the heart (second intracoastal space on the right )
Carotids
3-4

Question 21

Most severe AS ECG will show ___. Severe cases will show ____ and ___ in ___,___and___.

Answer 21

LVH
ST depression
T wave inversion
Leads I 
aVL
Left precordial leads

Question 22

ECG in AS will not show ___ between the ECG severity and AS status.

Answer 22

Good correlation

Question 23

What are the main findings in AS echo? (4)

Answer 23

Thickening
Calcifications
Reduce systolic opening of the valve
LVH

Question 24

What is the surface area of AS (severe, medium, light)

Answer 24

<1.5 cm2
1-1.5 cm2
1.5-2 cm2

Question 25

When using echo in order to assess AS, ____ is useful

Answer 25

Stress test

Question 26

Which AS patients will benefit from PCI?

Answer 26

1. Multivalvular disease 2. Young asymptomatic patients with congenital uncalcified valve 3. When suspecting the LV blockage to be above/below the valve

Question 27

Most AS patients die on their ___ or ___ decade of life

Answer 27

Seventh | Eights

Question 28

Most AS patients will show symptoms ____ before dying. They will show the following symptoms: ___, ___, ___.

Answer 28

``` 4 years Angina pectoris (3 years) Syncope (3 years) Dyspnea (2 years) CHF (1-0.5 years) ```

Question 29

Asymptomatic AS patients should be ___, using ___ to monitor the ___ and function

Answer 29

Followed up carefully ECG LV deterioration

Question 30

There is an indication for surgery for patients with severe AS (____) who are ____, ____ (EF<50%), ____, and aneurisms in the aortic root/ascending aorta.

Answer 30

<1 cm Symptomatic Treated + LV systolic deterioration BAV

Question 31

Asymptomatic patients with ____ to ___ AS who are going through CABG, should also be going through ____

Answer 31

Medium Severe AVR

Question 32

Relative indications for AVR include:

Answer 32

1. Abnormalities on stress test 2. Rapid progression of AS 3. Very severe AS + low surgical risk

Question 33

____ alone is not C/I for SAVR on AS patients

Answer 33

Age

Question 34

What is ross procedure?

Answer 34

AVR with autologous pulmonary valve, and the placement of homograft instead of the pulmonary valve

Question 35

____ is preferred on ____ and ____

Answer 35

PABV (percutaneous aortic balloon valvuloplasty) Children Young adults

Question 36

What does TAVI stands for?

Answer 36

Trans Aortic Valve Implantation

Question 37

Among ___ patients with ____ who are considered inoperable 1-2 year survival rates are ____ with TAVR than with medical therapy

Answer 37

Elderly Severe AS Significantly higher

Question 38

1-2 years survival rates are essentially ____ for high surgical risk patients treated with TAVI or SAVR

Answer 38

Equal

Question 39

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

Answer 39

Stroke | postprocedural paravalvur AR

Question 40

What is Class I AVR indication?

Answer 40

``` Severe AS + 1. symptomatic stage or 2. asymptomatic stage but a. LVEF<50% b. Other cardiac surgery ```