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AOV Test > Aortic Stenosis > Flashcards

Aortic Stenosis Flashcards

1
Q

What are the three causes of Aortic Stenosis?

A

Congenital, Degenerative, Rheumatic

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2
Q

What are the three types of Congenital causes?

A

Subvalvular, Valvular due to Bicuspid AOV, Supravalvular

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3
Q

With Bicuspid AOV you also need to look at the suprasternal notch for….

A

Aortic Coarctation

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4
Q

The resistance that the ventricles must overcome while ejecting blood

A

Afterload

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5
Q

What worsens as AS progresses?

A

Concentric Left Ventricular Hypertrophy

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6
Q

What happens to the LV late in the course of AS?

A

LV systolic dysfunction occurs=LVE @ end-systole and reduced contractility

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7
Q

What 3 things determine Afterload?

A

Semi-Lunar Valve Stenosis
High Arterial Blood Pressure
Increased Viscosity of Blood

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8
Q

2 other conditions that can increase afterload?

A

Renal Artery Stenosis

Coarctation of Aorta

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9
Q

Force-Velocity Relationship

A

The load the myocardial fibers produce to eject, the greater the afterload the worst the cardiac performance.

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10
Q

Velocity

A

The rate at which the fibers shorten during systole.

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11
Q

AS main etiologies

A

Degenerative
Congenital
Rheumatic

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12
Q

Degenerative

A

AKA senile. Degenerative calcification most common cause

65-70 yrs of age

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13
Q

Congenital

A

Bicuspid Valve, Subaortic membrane, supravalvular coarctation

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14
Q

Unlikely to see Rheumatic Aortic disease without…….

A

Mitral Stenosis cause by Rheumatic fever as well

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15
Q

Raphe

A

Underdeveloped cusp, will have one larger leaflet and one smaller

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16
Q

Sigmoid Septum

A

Thickening before the AOV. Common in older population.

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17
Q

Uni-Cuspid

A

Opens with a doming motion, single orifice with teardrop appearance

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18
Q

Cross sectional area x TVI=

A

Stroke Volume

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19
Q

Color M-Mode is superior in assessing

A

width of the jet

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20
Q

Echo Features in Degenerative/ Rheumatic

A

Cusp appearance- thickened, dense fibrotic
Cusp motion- Decreased cusp motion/excursion
LV wall appearance- Concentric Hypertrophy

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21
Q

When are AS symptoms seen?

A

Often not until AS is moderate to severe

22
Q

Symptoms of AS include:

A

DOE
Chest Pain
Possible exertional syncope
Heart Failure

23
Q

Murmur Heard

A

Harsh Systolic Ejection murmur
Crescendo-Descrendo in shape
Heard at RT upper-sternal border

24
Q

Sclerotic vs Stenotic

A

Sclerotic- cusps are calcified

Stenotic- flow is obstructed

25
Q

Low CO state would tend to ________ Pk velocity, and ________ valve area

A

underestimate, overestimate

26
Q

High CO state would tend to ________ Pk velocity and ________ valve area.

A

overestimate, underestimate

27
Q

SV x VTI=

A

CSA

28
Q

M-Mode of Bicuspid AOV

A

Eccentric Closure Line

29
Q

_______ is superior to M-Mode in the diagnosis of Bicuspid AOV.

A

2-D

30
Q

Malformation of leaflet and doming may be seen in ________

A

Early Systole

31
Q

Diastolic Doming may be present if __________

A

AOV prolapse

32
Q

Characteristic of Bicuspid AOV

A

Football or Cat Eye shape in Systole

33
Q

Results and Complications of AS

A

LV pressure overload

Concentric LV Hypertrophy

34
Q

What does a B-Bump finding on M-Mode indicate?

A

An Increase in LVEDP

35
Q

Increased Risk For?

A

Infective Endocarditis
Embolic Events
Serious Arrythmia
Sudden Death

36
Q

Importance of assessing LV size and fx?

A

Clinical Management
LV size at End Systole > 55 mm (indicates decomposition)
-timing of surgical event-

37
Q

What helps define the orifice, locate the stenotic jet, and locate/ assess regurgitation?

A

Color Doppler

38
Q

What is the preferred AVA method?

A

VTI Method

39
Q

Use PLAX view in early-mid systole to determine

A

LVOT diameter

0.5-1.0 cm from cusp

40
Q

Pitfalls of AVA calculations

A

Difficult to know where to take your PW Doppler sample in the LVOT.

41
Q

What is considered mild on AS Grading Criteria for Pk Pr Gradient?

A

16-36 mmHg

42
Q

What is considered moderate on AS Grading Criteria for Pk Pr Gradient?

A

36-64 mmHg

43
Q

What is considered severe on AS Grading Criteria for Pk Pr Gradient?

A

> 64 mmHg

44
Q

What is considered mild on AS Grading Criteria for Mean Pr Gradient?

A

< 30 mmHg

45
Q

What is considered moderate on AS Grading Criteria for Mean Pr Gradient?

A

30-50 mmHg

46
Q

What is considered severe on AS Grading Criteria for Mean Pr Gradient?

A

> 50 mmHg

47
Q

What is the AS gradient criteria for peak jet velocity?

A

> 4 m/s

48
Q

What is the normal valve area?

A

> 3-5 cm squared

49
Q

What is considered mild on valve area?

A

> 1.5 cm squared

50
Q

What is considered moderate on valve area?

A

1.1- 1.5 cm squared

51
Q

What is considered mild on valve area?

A

> 1.0 cm squared

52
Q

The AOV planimetry is taken when?

A

Early Systole

AOV Test (2 decks)

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