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ECHO 325 > Aortic Regurgitation > Flashcards

Aortic Regurgitation Flashcards

1
Q

What are 4 groups of mechanisms that cause aortic incompetence (AI)?

A

Cuspal abnormalities, aortic root dilation, aortic root distortion, loss of commissural support

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2
Q

Cuspal abnormalities includes what four things?

A

Congenital abnormalities, rheumatic aortic valve disease, aortic valve prolapse, infective endocarditis

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3
Q

What are some examples of congenital abnormalities?

A

Bicuspid or quadricuspid AV

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4
Q

What is quadricuspid AV associated with?

A

Anomalous coronary artery origin

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5
Q

What is rheumatic AV disease associated with?

A

Aortic stenosis, mitral regurgitation, and mitral stenosis

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6
Q

What is aortic bacterial endocarditis?

A

When vegetation destroys the AV

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7
Q

What does aortic root dilation do?

A

Prevents normal leaflet coaptation during diastole which leads to AR

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8
Q

What are six causes of aortic dilation?

A
  1. Systemic hypertension
  2. Atherosclerosis
  3. Connective tissue disorders
  4. Bicuspid AV
  5. Sinus of valsalva aneurysms
  6. Idiopathic dilation
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9
Q

What happens with aortic root distortion?

A

Root becomes distorted due to inflammatory process

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10
Q

Which inflammatory processes can lead to aortic root distortion?

A

Ankylosing spondylitis, takayasu’s arteritis, rheumatoid arthritis

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11
Q

Loss of commissural support may occur with what three things?

A

Ventricular septal defects, aortic dissections, aortic trauma

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12
Q

What are causes of acute severe AI?

A

Trauma, infective endocarditis, aortic dissection

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13
Q

How does acute sever AI affect filling pressures?

A

They will be increased, especially LVEDp

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14
Q

How does acute-severe AI increase EDP?

A

Regurg volume leaks back into the LV as well as the normal blood flow from the LA. Since it happens suddenly, the LV has not had time to stretch to accomodate for extra volume, therefore increasing pressure dramatically.

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15
Q

Acute-severe AI may cause the early closure of the MV, why?

A

LV pressure rises faster than normal

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16
Q

What would the filling pressures look like in someone with chronic-severe AI?

A

Normal or slightly elevated

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17
Q

With chronic-severe AI, LV chamber size increases over time due to stretching. This may lead to what through the AV?

A

Increased forward volume

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18
Q

Why would filling pressures appear normal in someone with chronic-severe AI?

A

Chamber sizes have had time to increase to accommodate for more volume

19
Q

In chronic-severe AI, the LV mass will increase, known as what kind of hypertrophy?

A

Eccentric

20
Q

What is one of the most common causes of acute severe AI?

A

Infective endocaditis

21
Q

What is an infective endocarditis?

A

Hypermobile mass on the underside of the AV

22
Q

The width of the vena contracta is less influenced by what?

A

Loading conditions

23
Q

What is jet height/LVOT ratio?

A

Measurement of jet height (LVOT level jet alias measurement in PLAX) divided by the LVOT

24
Q

What is is mild and severe jet height/LVOT ratio?

A

Mild = < 25%

Severe = ≥65%

25
Q

What is jet area/LVOT area ratio?

A

Trace of jet circle divided by trace of AV root circle in PSAX

26
Q

What is considered to be a mild and severe jet area/LVOT area ratio?

A

Mild = <5%

Severe = > 60%

27
Q

What is considered a mild vena contracta?

A

<3 mm

28
Q

What is considered a severe vena contracta?

A

≥6 mm

29
Q

What would a bright signal indicate in terms of a waveform for AI?

A

More significant AI

30
Q

If flow reversal is seen in the abdominal aorta, what does this usually indicate?

A

Severe AI

31
Q

What does a steep slope indicate with pressure half time?

A

Severe regurg

32
Q

What are the mild, mod and severe pressure half time values?

A

Mild: >500 ms

Mod: 200-500

Severe: < 200

33
Q

Why does severe AI have a steeper slope?

A

AI causes pressure in LV to rise faster than normal, this causes the pressure gradient between the LV and AO to drop faster = steeper slope.

34
Q

The stroke volume of a regurgitant valve will be higher than what?

A

The stroke volume of a normal valve

35
Q

How can you get regurgitant volume from stroke volume?

A

SV difference between a competent valve and a regurgitant valve.

36
Q

What is a quantitative method to assess AI?

A

PISA

37
Q

What does PISA stand for?

A

Proximal isovelocity surface area

38
Q

What is the formula for regurgitant volume?

A

RV = SVcompvalve - SVregurgvalve

Or

RV = CSAcv x VTIcv - CSArv x VTIrv

39
Q

What are the mild and severe values for regurg volume?

A

Mild < 30 mL

Severe >60 mL

40
Q

What is the AV regurgitant fraction?

A

RF(Ao) = ((SV(av) - SV(pv)) ÷ SV(av)) X 100

41
Q

What is considered a mild regurgitant fraction?

A

<30%

42
Q

What is considered a severe regurgitant fraction?

A

> 50%

43
Q

What are two ways AI can affect the mitral valve?

A
  1. AML doming (seen in PSAX)

2. AML flutter

43
Q

What two things diagnose severe AI off the bat?

A
  1. Vena contracta >6mm

2. Reversal in desc Ao

ECHO 325 (19 decks)

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