6.3 MTB Step 3 - Valvular Heart Disease (Aortic Regurgitation) Flashcards

1
Q

AORTIC REGURGITATION (AR)

  1. What are (4) Common Causes of AR?
  2. What are (4) Rarer Causes of AR?
A

Common Causes of AR:

  1. Hypertension (HTN)
  2. Rheumatic Heart Disease
  3. Endocarditis
  4. Cystic Medial Necrosis

Rarer Causes of AR:

  1. Marfan Syndrome
  2. Ankylosing Spondylitis
  3. Syphilis
  4. Reactive Arthritis - inflammatory arthritis of Large Joints, Inflammation of the Eyes (conjunctivitis & Uveitis), and Urethritis
    • ​​”Can’t See, Can’t Pee, Can’t climb a Tree”
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2
Q

AORTIC REGURGITATION (AR)

What is the Most Common Presentation of AR?

A

Shortness of Breath (SOB)

+

Fatigue

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3
Q

AORTIC REGURGITATION (AR)

Describe the Murmur of AR and where it is Best Heard on Auscultation?

A

Diastolic Descrescendo murmur Heard Best at the Left Sternal Border

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4
Q

AORTIC REGURGITATION (AR)

What are (5) Unique Physical Findings that are rarely seen with AR?

A
  1. Quincke Pulse: Arterial or Capillary pulsations in the Fingernails
  2. Corrigan Pulse: High bounding pulses (a.k.a. “water-hammer pulse”)
  3. Musset Sign: Head Bobbing up & down w/ each pulse
  4. Duroziez Sign: Murmur Heard over the Femoral Artery
  5. Hill Sign: Blood Pressure gradient MUCH Higher in the Lower Extremities
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5
Q

AORTIC REGURGITATION (AR)

  1. What is the Best INITIAL Diagnostic Test for AR?
  2. What is a MORE Accurate Diagnostic Test for AR?
  3. What is the Most ACCURATE Diagnostic Test for AR?
A
  1. TTE
  2. TEE
  3. Left Heart Catheterization

**For CSS, also choose ECG & CXR (shows LVH)**

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6
Q

AORTIC REGURGITATION (AR)

What are (3) Best INITIAL Therapies for AR?

A
  1. ACEIs
  2. ARBs
  3. Nifedipine

**For CSS, add a Loop Diuretic (e.g., Furosemide)**

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7
Q

AORTIC REGURGITATION (AR)

For which (2) Conditions is Surgery the answer for AR Treatment, even if the patient is Asymptomatic?

A

EF < 55%

or

LVESD > 55mm

EF = Ejection Fraction

LVESD = Left Ventricular End Systolic Diamter

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8
Q

AORTIC REGURGITATION (AR)

Why does High pressure Dilate the Aortic Valve?

A

Law of LaPlace: The Wall Tension (force dilating a vessel) is proportionate to the Radius of the vessel times the Pressure on the inside of the vessel:

Tension = Radius x Pressure

  • The Wider a vessel is, the Faster it will get pulled apart.
  • Hence, the More the Aortic Ring or Aorta is Dilated, the Faster it will get pulled apart.
  • Likewise, the Higher the Interior Pressure is, the Faster the Interior will be pulled apart.
  • This force of being “Pulled Apart” (dilation) is called “Wall Tension” in the Law of LaPlace.
  • ACEIs and ARBs Vasodilate Peripheral Arterioles (Lower Pressure = Lower Wall Tension)
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