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Fall Cardiac Theory > Aortic Insufficiency > Flashcards

Aortic Insufficiency Flashcards

1
Q

What causes Aortic Insufficiency?

A
  1. Congenital
  2. Calcific Degenerative Process
  3. Rheumatic
  4. Other Autoimmune causing inflammation
  5. Myxomatous Valve Disease
  6. Endocarditis
  7. Idiopathic Aortic Root Dilation & Annulus Dilation
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2
Q

Name the other autoimmune conditions that cause inflammation

A
  1. lupus
  2. rheumatoid arthritis
  3. ankylosing spondylitis
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3
Q

Describe the process of RHEUMATIC FEVER

A
  • overactive antibodies inflame and scar connective tissue leading to fibrosis of leaflets and chordae or aortic root dilation
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4
Q

What causes RHEUMATIC FEVER?

A

response to untreated strep

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5
Q

Describe the process of MYXOMATOUS VALVE DISEASE

A

connective tissue disorder where cusps become thickened, elongated and redundant (fold onto themselves)

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6
Q

What does MYXOMATOUS VALVE DISEASE lead too?

A

leads to AV prolapse

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7
Q

What is the the MOST COMMON cause of Acute AI?

A

Endocarditis

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8
Q

Describe the process of ENDOCARDITIS

A

infection of the endocardium that can lead to growth on leaflets OR destruction of valvular tissue

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9
Q

What is the MOST COMMON cause of CHRONIC AI?

A

Idiopathic Aortic Root Dilation and Annulus Dilation

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10
Q

Describe the process of MARFAN SYNDROME

A

inherited connective tissue disorder that affects eyes, skeleton and cause cause AR, AV, or AMVL to dilate

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11
Q

Describe the process of CYSTIC MEDIAL NECROSIS

A

disorder of large arteries- focal degeneration of elastic tissue and muscle in the tunica media

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12
Q

Marfans Syndrome is seen in what types of individuals?

A

very tall and thin individuals

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13
Q

What are the symptoms of AI?

A

(decrease cardiac output)
DOE
dizziness
angina
fatigue
syncope

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14
Q

What are signs of AI?

A

-signs of overload to pulmonary vasculature
- palpitations due to LVE
- wide pulse pressure

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15
Q

What are the symptoms of OVERLOAD TO PULMONARY VASCULATURE

A
  1. Dyspnea/DOE
  2. Orthopnea
  3. PND Paroxysmal Nocturnal Dyspnea
  4. Cough
  5. Rales or crackles
  6. Sputum (blood tinged sputum = hemoptysis)
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16
Q

What type of AUSCULTATION is heard with AI? And where is it heard?

A

blowing diastolic decrescendo murmur at upper RSB

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17
Q

What kind of PALPITATION is heard and where is it done?

A

-pulsus bisferiens
-CCA
- only for significant AI

18
Q

What are the treatments for AI?

A

-AVR
-medications to prevent/ease failure
- prophylactic antibiotics

19
Q

When is AVR done?

A
  • if patient is symptomatic
  • if patient is asymptomatic and LVIDs > 5cm or EF below normal
20
Q

Define preload

A

volume that the LV needs to overcome in order to push the volume into the systemic circulation

21
Q

Define afterload

A

pressure that the LV needs to overcome in order to push the volume into the systemic circulation

22
Q

What type of medications are given to prevent/ease failure and what do they do?

A
  1. vasodilators - decrease afterload
  2. diuretics - decrease preload
  3. nitrates - dilate coronary arteries
  4. digoxin - increase force of LV contraction
23
Q

Name other Aortic Root Abnormalities

A
  1. aortic aneurysm
  2. dissection
  3. coarctation
24
Q

What is COARCTATION

A

obstruction/narrowing of descending aorta and is congenital

25
Q

What conditions lead to Aortic Root Abnormalities

A
  1. chronic hypertension
  2. marfan syndrome
  3. cystic medial necrosis
26
Q

What are the 8 2D FINDINGS for AI?

A
  1. incomplete closure of cusps
  2. anatomic abnormality of valve or root
  3. hyperkinesis
  4. LVE
  5. eventual decrease of LVSF
  6. possible fine fluttering & reversed dooming of AMVL
  7. course flutter with AFib/Flutter if jet on AMVL
  8. possible fibrotic contact lesion on septum or AMVL
27
Q

What are the M Mode FINDINGS for AI?

A
  1. incomplete closure of cusps
  2. IVS motion is exaggerated w/hyperkinesis
  3. damping = increase in EPSS if jet directed on AMVL
  4. LVE
  5. premature closure of MV and opening of AV
28
Q

Pulsus Bisferiens means there are 2?

A

systolic peaks

29
Q

CHRONIC OR ACUTE FINDING: Possible raised fibrotic contact lesion on septum or AMVL

A

chronic AI

30
Q

CHRONIC OR ACUTE FINDING: Premature closure of MV and opening of AV on M Mode

A

acute severe AI

31
Q

Label chart for JET DIAMETER/LVOTd
Modality
View
Location
Measurement
Timing

A
  • Color Flow
  • PLAX/A5/A3
  • LVOT jet
  • LVOTd & Jet Diameter
  • Diastole
  • 2D
  • PLAX/A5/A3
  • LVOT
  • LVOTd
  • Diastole
32
Q

Label chart for AI PHT
Modality
View
Location
Measurement
Timing

A
  • CW
  • A5
  • Ao closure or through AI jet
  • PHT
  • Diastole
33
Q

Norms for JET and LVOT diameter/area

A

< 25 % = mild AI
25-64 % = moderate AI
> 64 % = severe AI

34
Q

Norms for color flow VENA CONTRACTA width

A

< . 3cm = mild
.3 - .6cm = moderate
> .6cm = severe

35
Q

Norms for PHT

A

> 500 msec = mild
200-500 msec = moderate
< 200 = severe

36
Q

What are you measuring based on SV AT 2 INTRACARDIAC SITES?

A

RV
RF
EROAcm2

37
Q

What is the equation for RV

A

RV = LVOT SV (TSV) - MITRAL SV (FSV if no MR)

38
Q

What is the equation for RF

A

RF = RV / LVOT SV x 100

39
Q

Norms for RV?

A

<= 30 ml = mild
30 - <60 ml= moderate
> 60ml = severe

40
Q

Norms for RF?

A

</= 30% = mild
30 - <50% = moderate
> 50% = severe

41
Q

Norms for EROAcm2?

A

< .10 = mild
.10 - <.30 = moderate
>.30 = severe

42
Q

What is the equation for EROAcm2?

A

EROA cm2 = RV /VTI RJ

Fall Cardiac Theory (18 decks)

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