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SPR2015_Week2 > Aortic and PUlmonary Valve disease > Flashcards

Aortic and PUlmonary Valve disease Flashcards

1
Q

aortic root

A

aortic leaflet

outflow of LV

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2
Q

three major pathologies of aortic stenosis

A

1) bicuspid = raphe = fusion btwn 2 cusps
2) calcific = restrict movement of valve
3) rheumatic = commissures fused with calcification

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3
Q

what happens before aortic stenosis

A

aortic sclerosis

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4
Q

define aortic sclerosis

A

thickening of valve but not significant degradation

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5
Q

progression of aortic stenosis

A

1) calcium deposit
2) sclerosis
3) mild fibrosis
4) severe stenosis
5) restrict motion of leaflet and incr velocity

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6
Q

hemodynamics in aortic stenosis

A

higher velocity through aortic stenotic valve

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7
Q

patients at risk of AS

A

aortic sclerosis

bicuspid valve

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8
Q

physical exam in aortic stenosis

A

1) palpable systolic thrill on chest

2) palpable thrill at neck due to delay blood flow to neck

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9
Q

auscultation of aortic stenosis

A

closing of aortic valve later than pulmonic vlave due to delayed ejection from LV

narrowing between valve closure with inspiration

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10
Q

Indications for aortic valve replacement

A

1) symptomatic

2) asymptomatic + low LVEF
asymptomatic + high gradient

3) symptomatc

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11
Q

What is now believed mechanism by which healthy tricuspid aortic valve becomes stenotic?

A

atherosclerosis

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12
Q

when does tricuspid valve most commonly become stenotic

A

60’s, 70’s, 80’s

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13
Q

why does tricuspid valve become stenotic

A

calcium deposits in valve cusps

NOT FUSION OF COMMISSURES

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14
Q

what is a rare cause of aortic stenosis in developed countries

A

rheumtatic fever

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15
Q

if aortic valve is affected by rheumatic heart disease what else is also affected?

A

mitral valve also affected

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16
Q

what is mainstay for diagnosiing aortic valve disease?

A

echo + Doppler interrogation of aortic valve

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17
Q

what is recommended treatment for symptomatic severe aortic stenosis

A

valve replacement (must have strong indications)

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18
Q

what is outlook for patients receiving aortic valve replacmeent

A

75% death within 3 yrs of sx onset

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19
Q

what are cardinal symptoms of severe aortic stenosis

A

1) angina
2) syncope
3) SOB and heart failure

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20
Q

what is most common congentical cardiac malformation?

A

BICUSPID AORTIC VALVE

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21
Q

how do bicuspid aortic valves form?

A

due to abnromal aortic cusp formation during valvulogenesis –> forms raphe

–> cusps fuse to form bigger cusp (smaller than 2 indiv cusps)

–> COMPLEX DEVELOPMENTAL

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22
Q

after development, what is bicuspid aortic valve associated with?

A

1) aortic dilation of prox ascending aorta due to abnormalities in aortic media
2) aneurysms
3) dissection

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23
Q

despite developmental effect, what should bicuspid aortic valve be considered as?

A

disease of entire aortic root (affects elastic lamina of aortic media)

24
Q

what is cellular effects of bicuspid aortic valve

A

1) decr microfibrillar elements
2) smooth muscle detachment
3) MMP release
4) matrix disruption
5) cell death
6) loss support, elasticity

25
Q

what is inheritance of bicuspid aortic valve

A

autosomal dominant + reduced penetrance

26
Q

which gender is more likely affected with bicuspid aortic valve hereditary

A

males 4:1

ECHO SCREEN 1ST DEGR RELATIVES

27
Q

valvular complications of bicuspid aortic valve

A

1) aortic stenosis
2) aortic insufficency
3) endocarditis

28
Q

describe aortic stenosis with bicuspid aortic valve

A

1) most common
2) age 15-65
3) rapid in asymmetric valves/Ant-post valves

29
Q

describe aortic insufficency in bicuspid aortic valve

A

1) cusp prolapse

30
Q

which patient population gets endocarditis with bicuspid aortic valve

A

young and with AI

31
Q

vascular complications of bicuspid aortic valve

A

1) aortic dilation
2) aneurysm form
3) aortic dissection
4) coarctation
5) PDA
6) coronary disease

32
Q

classifications of bicupsid aortic valve

A

1) after sabet

2) after roberts

33
Q

auscultation in bicuspid aortic valve

A

a

34
Q

HOW DO YOU manage bicuspid aortic valve

A

1) serial assay with echo to get functional status of valve and measure

35
Q

which group of bicuspid aortic valve patients should be monitored consistently with

A

pts with mild-to-mod valvular dysfunction

normal LV dimensions/function

36
Q

other form of aortic stenosis

A

1) subvalvular disease

2) hypertrophic obstructive cardiomyopathy

37
Q

describe subvalvular disease

A

1) thin membrane
2) thick fibromuscular ridge
3) diffuse tunnel obstruction

38
Q

describe hypertrophic obstructive cardiomyopathy

A

1) abnromal mitral valve attachments

2) accessory endocardial cusion tissue

39
Q

valvular diseases with aortic regurgitation

A

1) Rheumatic
2) degenerative
3) endocarditis
4) congenital (bicuspid/quadricuspid)

40
Q

diseases of aorta with aortic regurg

A

1) dissection
2) marfan’s
3) atherosclerosis
4) annuloartic ectasia
5) syphilis
6) ankylosing spondyltiis
7) osteogenesis imperfecta

41
Q

heart sound with aortic regurg

A

diastolic murmur

starts at S2–> descrendo (high pitch)

42
Q

signs of aortic regurg

Corrigan’s pulse

A

Rapid forceful carotid upstroke followed by rapid decline

43
Q

signs of aortic regurg

Quincke’s pulse

A

Diastolic blanching in nail bed when slightly compressed

44
Q

signs of aortic regurg

de Musset’s sign

A

bobbing of head

45
Q

signs of aortic regurg

Durozie’s sign

A

Systolic and diastolic femoral bruits when compressed with stethoscope

46
Q

signs of aortic regurg

Hill’s sign

A

Systolic BP in legs > 30 mmHg than in arms

47
Q

grading of aortic regurg

A

use echocardiogram to measure jet return from aorta back to LV

48
Q

indications for AR

A

severe AR with symptoms

49
Q

a

A

a

50
Q

a

A

a

51
Q

a

A

a

52
Q

most common patient group with pulmonic stenosis

A

children

but can come in during adolescence/adulthood

53
Q

new main treatment for pulmonic valve stenosis

A

percutaenous balloon valvuloplaty

EXCEPT FOR PEOPLE WITH DYSPLASTIC VALVES

54
Q

old treatment for pulmonic valve stenosis

A

surgical valvotomy

55
Q

Difference btwn mechanical and bioprosthesis

A

1) mechanical = need warfarin + long lasting

2) in older 70-80 y/o patients because more likely to degenerate

SPR2015_Week2 (19 decks)

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