Aortic and PUlmonary Valve disease Flashcards
aortic root
aortic leaflet
outflow of LV
three major pathologies of aortic stenosis
1) bicuspid = raphe = fusion btwn 2 cusps
2) calcific = restrict movement of valve
3) rheumatic = commissures fused with calcification
what happens before aortic stenosis
aortic sclerosis
define aortic sclerosis
thickening of valve but not significant degradation
progression of aortic stenosis
1) calcium deposit
2) sclerosis
3) mild fibrosis
4) severe stenosis
5) restrict motion of leaflet and incr velocity
hemodynamics in aortic stenosis
higher velocity through aortic stenotic valve
patients at risk of AS
aortic sclerosis
bicuspid valve
physical exam in aortic stenosis
1) palpable systolic thrill on chest
2) palpable thrill at neck due to delay blood flow to neck
auscultation of aortic stenosis
closing of aortic valve later than pulmonic vlave due to delayed ejection from LV
narrowing between valve closure with inspiration
Indications for aortic valve replacement
1) symptomatic
2) asymptomatic + low LVEF
asymptomatic + high gradient
3) symptomatc
What is now believed mechanism by which healthy tricuspid aortic valve becomes stenotic?
atherosclerosis
when does tricuspid valve most commonly become stenotic
60’s, 70’s, 80’s
why does tricuspid valve become stenotic
calcium deposits in valve cusps
NOT FUSION OF COMMISSURES
what is a rare cause of aortic stenosis in developed countries
rheumtatic fever
if aortic valve is affected by rheumatic heart disease what else is also affected?
mitral valve also affected
what is mainstay for diagnosiing aortic valve disease?
echo + Doppler interrogation of aortic valve
what is recommended treatment for symptomatic severe aortic stenosis
valve replacement (must have strong indications)
what is outlook for patients receiving aortic valve replacmeent
75% death within 3 yrs of sx onset
what are cardinal symptoms of severe aortic stenosis
1) angina
2) syncope
3) SOB and heart failure
what is most common congentical cardiac malformation?
BICUSPID AORTIC VALVE
how do bicuspid aortic valves form?
due to abnromal aortic cusp formation during valvulogenesis –> forms raphe
–> cusps fuse to form bigger cusp (smaller than 2 indiv cusps)
–> COMPLEX DEVELOPMENTAL
after development, what is bicuspid aortic valve associated with?
1) aortic dilation of prox ascending aorta due to abnormalities in aortic media
2) aneurysms
3) dissection
despite developmental effect, what should bicuspid aortic valve be considered as?
disease of entire aortic root (affects elastic lamina of aortic media)
what is cellular effects of bicuspid aortic valve
1) decr microfibrillar elements
2) smooth muscle detachment
3) MMP release
4) matrix disruption
5) cell death
6) loss support, elasticity
what is inheritance of bicuspid aortic valve
autosomal dominant + reduced penetrance
which gender is more likely affected with bicuspid aortic valve hereditary
males 4:1
ECHO SCREEN 1ST DEGR RELATIVES
valvular complications of bicuspid aortic valve
1) aortic stenosis
2) aortic insufficency
3) endocarditis
describe aortic stenosis with bicuspid aortic valve
1) most common
2) age 15-65
3) rapid in asymmetric valves/Ant-post valves
describe aortic insufficency in bicuspid aortic valve
1) cusp prolapse
which patient population gets endocarditis with bicuspid aortic valve
young and with AI
vascular complications of bicuspid aortic valve
1) aortic dilation
2) aneurysm form
3) aortic dissection
4) coarctation
5) PDA
6) coronary disease
classifications of bicupsid aortic valve
1) after sabet
2) after roberts
auscultation in bicuspid aortic valve
a
HOW DO YOU manage bicuspid aortic valve
1) serial assay with echo to get functional status of valve and measure
which group of bicuspid aortic valve patients should be monitored consistently with
pts with mild-to-mod valvular dysfunction
normal LV dimensions/function
other form of aortic stenosis
1) subvalvular disease
2) hypertrophic obstructive cardiomyopathy
describe subvalvular disease
1) thin membrane
2) thick fibromuscular ridge
3) diffuse tunnel obstruction
describe hypertrophic obstructive cardiomyopathy
1) abnromal mitral valve attachments
2) accessory endocardial cusion tissue
valvular diseases with aortic regurgitation
1) Rheumatic
2) degenerative
3) endocarditis
4) congenital (bicuspid/quadricuspid)
diseases of aorta with aortic regurg
1) dissection
2) marfan’s
3) atherosclerosis
4) annuloartic ectasia
5) syphilis
6) ankylosing spondyltiis
7) osteogenesis imperfecta
heart sound with aortic regurg
diastolic murmur
starts at S2–> descrendo (high pitch)
signs of aortic regurg
Corrigan’s pulse
Rapid forceful carotid upstroke followed by rapid decline
signs of aortic regurg
Quincke’s pulse
Diastolic blanching in nail bed when slightly compressed
signs of aortic regurg
de Musset’s sign
bobbing of head
signs of aortic regurg
Durozie’s sign
Systolic and diastolic femoral bruits when compressed with stethoscope
signs of aortic regurg
Hill’s sign
Systolic BP in legs > 30 mmHg than in arms
grading of aortic regurg
use echocardiogram to measure jet return from aorta back to LV
indications for AR
severe AR with symptoms
a
a
a
a
a
a
most common patient group with pulmonic stenosis
children
but can come in during adolescence/adulthood
new main treatment for pulmonic valve stenosis
percutaenous balloon valvuloplaty
EXCEPT FOR PEOPLE WITH DYSPLASTIC VALVES
old treatment for pulmonic valve stenosis
surgical valvotomy
Difference btwn mechanical and bioprosthesis
1) mechanical = need warfarin + long lasting
2) in older 70-80 y/o patients because more likely to degenerate
