Aortic Insufficiency Flashcards
What causes Aortic Insufficiency?
- Congenital
- Calcific Degenerative Process
- Rheumatic
- Other Autoimmune causing inflammation
- Myxomatous Valve Disease
- Endocarditis
- Idiopathic Aortic Root Dilation & Annulus Dilation
Name the other autoimmune conditions that cause inflammation
- lupus
- rheumatoid arthritis
- ankylosing spondylitis
Describe the process of RHEUMATIC FEVER
- overactive antibodies inflame and scar connective tissue leading to fibrosis of leaflets and chordae or aortic root dilation
What causes RHEUMATIC FEVER?
response to untreated strep
Describe the process of MYXOMATOUS VALVE DISEASE
connective tissue disorder where cusps become thickened, elongated and redundant (fold onto themselves)
What does MYXOMATOUS VALVE DISEASE lead too?
leads to AV prolapse
What is the the MOST COMMON cause of Acute AI?
Endocarditis
Describe the process of ENDOCARDITIS
infection of the endocardium that can lead to growth on leaflets OR destruction of valvular tissue
What is the MOST COMMON cause of CHRONIC AI?
Idiopathic Aortic Root Dilation and Annulus Dilation
Describe the process of MARFAN SYNDROME
inherited connective tissue disorder that affects eyes, skeleton and cause cause AR, AV, or AMVL to dilate
Describe the process of CYSTIC MEDIAL NECROSIS
disorder of large arteries- focal degeneration of elastic tissue and muscle in the tunica media
Marfans Syndrome is seen in what types of individuals?
very tall and thin individuals
What are the symptoms of AI?
(decrease cardiac output)
DOE
dizziness
angina
fatigue
syncope
What are signs of AI?
-signs of overload to pulmonary vasculature
- palpitations due to LVE
- wide pulse pressure
What are the symptoms of OVERLOAD TO PULMONARY VASCULATURE
- Dyspnea/DOE
- Orthopnea
- PND Paroxysmal Nocturnal Dyspnea
- Cough
- Rales or crackles
- Sputum (blood tinged sputum = hemoptysis)
What type of AUSCULTATION is heard with AI? And where is it heard?
blowing diastolic decrescendo murmur at upper RSB
What kind of PALPITATION is heard and where is it done?
-pulsus bisferiens
-CCA
- only for significant AI
What are the treatments for AI?
-AVR
-medications to prevent/ease failure
- prophylactic antibiotics
When is AVR done?
- if patient is symptomatic
- if patient is asymptomatic and LVIDs > 5cm or EF below normal
Define preload
volume that the LV needs to overcome in order to push the volume into the systemic circulation
Define afterload
pressure that the LV needs to overcome in order to push the volume into the systemic circulation
What type of medications are given to prevent/ease failure and what do they do?
- vasodilators - decrease afterload
- diuretics - decrease preload
- nitrates - dilate coronary arteries
- digoxin - increase force of LV contraction
Name other Aortic Root Abnormalities
- aortic aneurysm
- dissection
- coarctation
What is COARCTATION
obstruction/narrowing of descending aorta and is congenital
What conditions lead to Aortic Root Abnormalities
- chronic hypertension
- marfan syndrome
- cystic medial necrosis
What are the 8 2D FINDINGS for AI?
- incomplete closure of cusps
- anatomic abnormality of valve or root
- hyperkinesis
- LVE
- eventual decrease of LVSF
- possible fine fluttering & reversed dooming of AMVL
- course flutter with AFib/Flutter if jet on AMVL
- possible fibrotic contact lesion on septum or AMVL
What are the M Mode FINDINGS for AI?
- incomplete closure of cusps
- IVS motion is exaggerated w/hyperkinesis
- damping = increase in EPSS if jet directed on AMVL
- LVE
- premature closure of MV and opening of AV
Pulsus Bisferiens means there are 2?
systolic peaks
CHRONIC OR ACUTE FINDING: Possible raised fibrotic contact lesion on septum or AMVL
chronic AI
CHRONIC OR ACUTE FINDING: Premature closure of MV and opening of AV on M Mode
acute severe AI
Label chart for JET DIAMETER/LVOTd
Modality
View
Location
Measurement
Timing
- Color Flow
- PLAX/A5/A3
- LVOT jet
- LVOTd & Jet Diameter
- Diastole
- 2D
- PLAX/A5/A3
- LVOT
- LVOTd
- Diastole
Label chart for AI PHT
Modality
View
Location
Measurement
Timing
- CW
- A5
- Ao closure or through AI jet
- PHT
- Diastole
Norms for JET and LVOT diameter/area
< 25 % = mild AI
25-64 % = moderate AI
> 64 % = severe AI
Norms for color flow VENA CONTRACTA width
< . 3cm = mild
.3 - .6cm = moderate
> .6cm = severe
Norms for PHT
> 500 msec = mild
200-500 msec = moderate
< 200 = severe
What are you measuring based on SV AT 2 INTRACARDIAC SITES?
RV
RF
EROAcm2
What is the equation for RV
RV = LVOT SV (TSV) - MITRAL SV (FSV if no MR)
What is the equation for RF
RF = RV / LVOT SV x 100
Norms for RV?
<= 30 ml = mild
30 - <60 ml= moderate
> 60ml = severe
Norms for RF?
</= 30% = mild
30 - <50% = moderate
> 50% = severe
Norms for EROAcm2?
< .10 = mild
.10 - <.30 = moderate
>.30 = severe
What is the equation for EROAcm2?
EROA cm2 = RV /VTI RJ
