Aortic Stenosis Flashcards by Sarah Elizabeth

what are the common causes of aortic stenosis

calcific degeneration
bicuspid valve
rheumatic

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what does aortic stenosis cause

increased pressure in LV

-> LVH
-> LV dilatation
-> LV failure

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which cause of aortic stenosis tends to present in 40-50s

bicuspid aortic valve

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which cause of aortic stenosis can present at any age

rheumatic heart disease

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in which age group does degenerative AS present in

70s - 80s

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what are the features of Marfan’s syndrom

MV prolapse
aortic weakness
high arched palate
lens dislocation

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which is the most common congenital heart disease

bicuspid AV

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what is Heyde’s syndrom

angiodysplasia of the colon presenting with iron deficiency anaemia
can be due to a form of vW disease

tubulence around the stenoses AV may cause the breakdown of fVIII

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what is the radiographic sign of coarctation

ribnotching

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what is William’s syndrome

neurodevelopment disorders
children have dysmorphic appearance
subaortic membrane may be present
associated with hypercalcaemia

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what are the 4 defects present in Shone’s disease

4 left sided defects:

1) supravalvular mitral membrane
2) parachute mitral valve
3) subaortic stenosis
4) coarctation of the aorta

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how does rheumatic/scarlet fever present

strep infection

1) sore throat –> febrile
2) pancarditis –> HF/mitral murmurs

If left untreated fibrotic valves and commissures fuse

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why does heart failure occur if aortic stenosis is not removed

CO cannot increase

-> systolic BP falls leading to coronary ischaemia
-> myocardium fails
-> cardiac arrhythmias

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what is the Frank-starling curve defined by

x= afterload
y= inotropy

increasing after load or decreasing isotropy shifts the curve down and right

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what are the risk factors for calcific valves

old age
male
elevated lipoprotein and LDL
hypertension
diabetes
smoking

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what are the symptoms of aortic stenosis

SYNCOPE
ANGINA
DYSPNOEA
cold peripheries
low bp
oedema

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what are the signs of aortic stenosis

slow rising pulse
apex thrust
ejection systolic murmur radiating to the carotids
narrow pulse pressure

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what clinical signs would be present if there was aortic regurgitation

wide pulse pressure and a collapsing pulse

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what would a pan systolic murmur indicate

mitral regurgitation

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what would an ejection systolic murmur be indicative

aortic stenosis

what would a diastolic murmur be indicative of

aortic regurg; mitral stenosis

why is it important to perform an FBC on someone you suspect has aortic stenosis

to ensure not anaemic as can affect flow gradient

how is mild AS defined

AV PPG 10-35mmHg

AVA > 1 sq cm

how is moderate AS defined

AV PPG 35-65mmHg

AVA 0.6-1 sq cm

how is severe AS

AV PPG >65mmHg | AVA<0.6 sq cm

why is it important to maintain good dental hygiene in patients with mild -> moderate AS

endocarditis can be caused by Streptococcal viridans

why are vasodilators and venodilators (such as nitrates and ACE inhibitors) contraindicated in severe aortic stenosis

can cause syncope as blood pools in veins

in which group of patients might the Ross procedure be preferable

younger puts with CHD as valve grows as child grows, no need for anticoagulation

what are the disadvantages of xenograft valves

not good for very sick puts | will result in some aortic regurg as leafletswill not fully close

why do mechanical valves require high INRs

turbulence | valves are thrombogenic

is the first heart sound at the beginning of systole or diastole

systole

what happens as a result of increased CVP in heart failure

blood backs up in the capillary system and oedema forms

what determines CVP

venous return | rate at which blood leaves the right atrium

which 2 cranial nerves are involved in the baroreceptor reflex

vagus | glossopharyngeal

what is the definition of CVP

pressure within the right atrium

what is a Guyton curve

cardiac output plotted against CVP

which receptors are targeted by the sympathetic nervous system

beta-1 receptors

what methods are there for measuring CO

Rick's principle Hamilton's dilution test thermodilution pulsed doppler

what makes the first heart sound

closure of the mitral and tricuspid valve

how does a decrease in VR affect CVP

increases CVP and reduced difference between arterial and venous systems

which method for measuring CO is least invasive

pulsed doppler

where on the ECG correlated with the 2nd heart sound

the down stroke of the T wave

which method for measuring CO is most invasive and also accurate

Fick's principle

which treatments are used for heart failure

diuretics | digoxin

which valve closes to make the second heart sound

aortic

how does the body compensate for heart failure

attempts to increase aterial pressure and thus venous return/CO by increasing salt and water retention

where on the ECG does the first heart sound correlate

the peak of the R wave

which part of the brain co-ordinates ANS control of heart rate

medulla