Aortic Regurg

Question 1

Aortic Regurg: Etiology

Answer 1

1. Primary cusp disease
2. Dilated aortic annulus and root
3. Loss of commissural support
4. Prosthetic valve disease

Question 2

Aortic Regurg: Etiology–> Primary cusp disease

Answer 2

1. Stenosis
2. SBE
3. Ankylosing
4. Spondylitis

Question 3

Aortic Regurg: Etiology–> Dilated aortic annulus and root

Answer 3

1. Marfan
2. Aortitis
3. HTN
4. Aneurysm

Question 4

Aortic Regurg: Etiology–> Loss of commissural support

Answer 4

1. TYrama
2. Dissection
3. Membranous VSD

Question 5

Which anomaly goes with aortic dissection?

Answer 5

Marfan syndrome

Question 6

Aortic Regurg: Pathophysiology

Answer 6

1. Left ventricular volume overload
2. Decreased ejection fraction with long standing regurg
3. increased risk for endocarditis

Question 7

Aortic Regurg: Pathophysiology–> Left ventricular volume overload leads to?

Answer 7

LV dilation

Question 8

Aortic Regurg: Physical signs

Answer 8

1. Bounding, bifid (bisferious) arterial pulse

2. Wide pulse pressure during BP readings

Question 9

Aortic Regurg: Physical signs–> Wide pulse pressure

Answer 9

Big difference between systolic and diastolic numbers during BP readings

Question 10

Aortic Regurg: Physical signs–> Murmur

Answer 10

High pitched diastolic “blowing” murmur left sternal border (LSB)

Question 11

Aortic Regurg: Physical signs–> Symptoms of?

Answer 11

1. CHF
2. DOE
3. Angina
4. Syncope

Question 12

What kind of murmur would you hear in a patient with a rupture of a sinus of valsalva aneurysm?

Answer 12

continuous (AO ( increased pressure) going to decreased pressure to RA so cont. RA pressure 5/6 Ao is always higher)

Question 13

Aortic Regurg: M-mode

Answer 13

May show diastolic fluttering of the mitral valve leaflets (mostly anterior) or interventricular septum

Question 14

Aortic Regurg: Echo

Answer 14

1. MV “preclosure” with severe acute AR
2. Diastolic fluttering or a lack of closure of the Ao leaflets
3. Decreased excursion of the anterior MV leaflet
4. LV dilation with increased LV mass
5. AoV or root abnormalities may be present
6. Pre-systolic opening of the Ao leafltes
7. LV contractility may be hyper or hypodynamic (acute vs chronic)

Question 15

What is best for diagnosing aortic dissections?

Answer 15

TEE

Question 16

Chronic AR patients should have?

Answer 16

Serial echoes to follow changes in diastolic and systolic size

Question 17

What cuases MV preclosure?

Answer 17

An elevated LVEDP( end diastolic pressure)

Question 18

Where is normal MV closure?

Answer 18

MV closure is in the middle to the end of the QRS complex

Question 19

Aortic Regurg: Dopper–> Look for?

Answer 19

1. diastolic turbulence in the LVOT

2. Diastolic flow reversal in the descending aorta (mod to severe)

Question 20

Aortic Regurg: Obtain the end diastolic gradient from CW Doppler to estimate?

Answer 20

The LVEDP (diastolic BP- end diastolic gradient)

Question 21

Aortic Regurg: Map the regurg area with?

Answer 21

Pulsed or color flow doppler

Question 22

Aortic Regurg: Try to determine the regurg area in?

Answer 22

LAX and SAX to estimate severity

Question 23

Aortic Regurg: JH/LVOT (ratio)
mild=
mod=
severe=

Answer 23

Mild= <25%
mod= 22-65%
severe= >65%

Question 24

Ao Pressure 1/2 time
Mild=
Mod=
Severe=

Answer 24

Mild= >500msec
Mod= 500-200msec
Severe= <200msec

Question 25

You can also estimate the LVEDP from?

Answer 25

AI Doppler traces

Question 26

LVEDP equation?

Answer 26

LVEDP= diastolic BP- end diastolic gradient

Question 27

The descending aorta has what kind of flow?

Answer 27

diastolic flow reversal (retrograde)

Question 28

Antegrade=

Retrograde=

Answer 28

Antegrade= normal flow direction
Retrograde= flow in opposite direction

Question 29

Mild aortic regurg has?

Answer 29

An incomplete spectral trace