Aortic Stenosis Flashcards
what is the most common cause of AS?
degenerative
what does degeneration do to the valve
calcifies it
degeneration is an inflammatory response involving ________and________-. The lesions contain ______ which calcify
is an inflammatory response involving macrophaes and t lymphocytes. The lesions contain lipoproteins which calcify
what is a more common cause of AS in the young?
congenital e.g. bicuspid valve
what are some other causes of AS?
- rheumatic - This is not seen frequently anymore.
rheumatic HD tends to affect the _____ valve
mitral
what does rheumatic fever do to the valve
results in fusion, thickening and calcification of the valve
valvular aortic stenosis should be distinguished from other causes of obstruction to left ventricular emptying which include:
- supravalvular obstruction
- hypertrophic cardiomyopathy
- subvalvular aortic stenosis
Obstructed left ventricular emptying leads to increased ___ ______r pressure and compensatory ___ _____
hyper- trophy. In turn, this results in relative _____ of the left ventricular myocardium, and consequent angina, ______ and _______ ventricular failure .
Obstructed left ventricular emptying leads to increased left ventricular pressure and compensatory left ventricular hyper- trophy. In turn, this results in relative ischaemia of the left ventricular myocardium, and consequent angina, arrhyth- mias and left ventricular failure.
what are the symptoms? SAD
- syncope/dizziness
- angina
- dyspnoea
why do you get ischaemia?
because of LV hypertrophy- the heart has to work harder to get blood through the narrowed valve
_____ is an emergency in AS
syncope
what are the characteristics of the pulse in AS?
Low volume pulse - slow rising and weak
why is the pulse low volume ?
this is because AS means you can’t get blood from the main pump of the heart to the body
what is the apex beat like in AS?
Forceful displaced apex - due to LV hypertrophy
what is felt in the aortic area?
systolic thrill
what sounds are heard in AS?
- systolic ejection click,
- S4 - caused by atrial contraction
- reversed splitting of S2 on expiration
- Ejection systolic murmur that can radiate to the carotids
what happens to the S2?
it is quiet?
why is S2 quiet?
because the valve is hardly moving so second sound is quieter
what may be seen on ECG?
- big QRS because of LVH
If the patient is asymptomatic even with severe AS you ______ _____
If the patient is asymptomatic even with severe AS you don’t intervene
what is done if the patient starts to experience symptoms?
- Conventional valve replacement.
- Trans catheter aortic valve replacement TAVI
- Balloon Aortic valvotomy (BAV)
Conventional valve replacement. This can be____or _____ and the operation is done via _____. The survival for this is _____ ___.
Conventional valve replacement. This can be tissue or mechanical and the operation is done via sternotomy. The survival for this is very good.
under which circumstances are the valves not replaced?
if LV very dilated
what are the pros of mechanical prosthetic valves?
they last a long time.
what are the cons of mechanical prosthetic valves?
patients on warfarin because patients occasionally get valve thrombosis
who tends to get mechanical prosthetic valves?
young people
what are the pros of bio- prosthetic valves?
don’t need warfarin
what are the cons of bio- prosthetic valves?
they only last 10 years or so and are reserved for older patients
TAVI passed up the _____ artery.
The process involves the____ of the aortic valve
TAVI
passed up the femoral artery.
The process involves the crushing of the aortic valve
balloon aortic valvotomy is usuallly for who?
patients who are very frail and elderly
