Aortic Stenosis Flashcards
What Echo Findings can you see to determine AS?
- thick leaflets
- restricted leaflet motion
- reduced AV orifice in systole
- aortic insufficiency
- LVH due to pressure overload
- LAE
- decrease LVSF (late in course)
- post-stenotic dilatation of ascending aorta
Name symptoms of AS
- dyspnea on exertion
- angina
- dizziness/syncope
- hypotension
What is the most common symptoms of AS?
dyspnea on exertion
What would we hear on Auscultation?
harsh mid systolic ejection murmur
Where is the stethoscope placed to hear auscultation?
right upper sternal border
Where is Palpation done?
right CCA
What is the purpose of doing a Palpation?
recognizes “pulsus parvus et tardus” - rises slowly and is small sustained
How do you treat AS?
- AV replacement
- Medications
How do you determine when to do AV Replacment?
monitor symptoms and degree of stenosis
What treatment is definitive for AS?
AV Replacement
What is AV Replacement?
TAVR- catheter valve replacement
What type of antibiotics may be used?
prophylactic
What type of medications may slow progression of AV?
controlling BP and lowering lipid drugs
What type of medications would you give if in failure to ease failure and how would they help?
-diuretics to decrease volume
- beta blockers to slow rate
- nitrates to dilate coronaries
What are the 3 etiologies (causes) of AS?
- degenerative calcification of normal trileaflet
- congenital bicuspid
- rheumatic aortic stenosis
When does Degenerative Calcification present?
occurs over many year, presents at ages 70-85
How does Degenerative Calcification look on 2D SHORT Axis?
- closed AV appears very echogenic and filled with calcium that restricts the valve
- open AV is stellate shaped
How does AS appear on M Mode?
AV cusps flutter when opening
Most common cause of AS?
degenerative calcification
When do symptoms of Congenital Bicuspid appear?
ages ~45-65
How does Congenital Bicuspid appear on 2D SHORT AXIS?
valve can look normal due to raphe that takes on a football shape
What is a raphe?
fusion line that is not a true separation and runs across the larger leaflet
How does Congenital Bicuspid appear on 2D LONG AXIS?
dooming of leaflets into aorta in systole and diastole
How does Congenital Bicuspid appear on M MODE?
may show an eccentric closure line
When checking for stenosis in Congenital Bicuspid, what else should you look for?
-Aortic Insufficiency ( bicuspid always leak)
- dilation of sinuses and AR
When is Stenosed Unicuspid seen?
childhood or due to restenosis after valvutomy
What is Rheumatic Aortic Stenosis caused by?
untreated strep throat
What does Rheumatic Aortic Stenosis result in?
commissural fusion: points/line where leaflets join
How does Rheumatic Aortic Stenosis appear on 2D SHORT AXIS?
increased echogenicity along leaflet edges and commissural fusion
How does Rheumatic Aortic Stenosis appear on 2D LONG AXIS?
demonstrates systolic dooming
