Aortic and Pulmonic valve disease

Question 1

What are the cusps of the arotic valve

Answer 1

left (where left coronary artery comes out), right (where right coronary artery comes out) and Non (no branches of coronary artery)

Question 2

List and describe pathology of the arotic valves

Answer 2

Bicuspid (two of the valves fuse so there are only two commisures), Calcified valves (deposits), rheumatic valves (thickening anf fusion of all three valves)

Question 3

New classifications of aortic stenosis

Answer 3

A: at risk (aortic sclerosis, bicuspid valve). B: progressive aortic stenosis (mild/moderate). C: asymptomatic severe AS. D: Symptomatic severe AS

Question 4

X-ray and EKG findings in aortic stenosis

Answer 4

X-ray: hypertrophy (ventricular). EKG: large QRS (due to forceful ventricular conduction). Also, there is a big pressure gradient difference between the LV and the aorta

Question 5

Aortic sclerosis vs stenosis

Answer 5

sclerosis: valves are becoming thickened/calcified but there is not a large pressure gradient difference btw aorta and LV. Stenosis: large pressure gradient. Increases with age.

Question 6

Factors that lead to calcific aortic stenosis

Answer 6

Same factors that cause atherosclerosis (lipids, HTN, male, metabolic syndrome, etc)

Question 7

Process of aortic stenosis formation

Answer 7

lipid depostion increases followed by Ca deposition

Question 8

What methods are used to monitor aortic stenosis?

Answer 8

echocardiogram- We use the principle of doppler shift (echo waves will change based on the velocity of red cell movement, and with stenosis velocity increases). We also use Bernoulli equation to measure pressure gradients ( P1-P2 = 4(V2^2 - V1^2). We can measure aortic valve area using A2= (A1 x V1)/ V2

Question 9

Symptomatic aortic stenosis presentation

Answer 9

Syncope, heart failure(shortness of breath) and angina.

Question 10

prognosis of symptomatic vs asymptomatic AS

Answer 10

asymptomatic: same survival as normal population. Symptomatic: very bad prognosis

Question 11

Normal velocity of blood through aorta vs velocity in severe aortic stenosis

Answer 11

normal: 1m/second. Severe: >4m/second

Question 12

Indications for aortic valve replacement

Answer 12

severe AS w/ symptoms, severe AS w/out symptoms but LVEF <50%

Question 13

Types of aortic valve replacements

Answer 13

mechanical (used in younger people, usually have to be on coumadin) or bioprosthesis (wears out over time but patients don’t have to be on coumadin). Types of bioprosthesis: heterograph, homograph (cadaver), percutaneous (though catheter)

Question 14

When aortic valve is affected by rheumatic heart disease, what other valve is almost always affected as well

Answer 14

mitral valve

Question 15

Describe the bicuspid aortic valve

Answer 15

congenital cardiac malformation of the entire aortic root (enlarged ascending aorta) due to malformation of elastic laminae of aortic media and fusion of cusps during development

Question 16

complications of bicuspid aortic valve

Answer 16

Aorti stenosis, insufficiency (cusp prolapse), endocarditis, aortic dilation, aneurisym

Question 17

bicuspid aortic valve types

Answer 17

most common is fusion of left and right cusps

Question 18

Bicuspid aortic valve ausculation

Answer 18

usually has an ejection click

Question 19

Management of bicuspid aortic valve

Answer 19

monitor with echo

Question 20

aortic regurgitation causes

Answer 20

caused by disease of valve (rheumatic, degenerative, endocarditis, congenital) or disease of aorta (dissection, marfans, atherosclerosis, etc)

Question 21

symptoms of aortic regurgitation

Answer 21

Heart failure (shortness of breath)

Question 22

Signs of aortic regurgitation

Answer 22

Corrigans pulse (rapid carotid upstroke followed by rapid decline), Quinckes pulse (diastolic blanching in nail bed when compressed), de Musset’s sign (bobbing of head), Durozie’z sign (systolic and diastolic femoral bruits), Hill’s sign (systolic BP in legs >30mmHg than in arms)

Question 23

Aortic regurgitation prognosis

Answer 23

if symptomatic and/or low ejection fraction, prognosis is poor

Question 24

Pulmonic stenosis heart sounds

Answer 24

systolic ejection click that decreases with inspiration

Question 25

Forms of pulmonic stenosis

Answer 25

acommissural, unicommissural, bicuspid, dysplastic

Question 26

Evaluation of pulmonic stenosis

Answer 26

ECG, doppler echo and cardiac catheterization

Question 27

Treatment of pulmonic stenosis

Answer 27

Percutaneous balloon valvuloplasty has largely replaced surgery