Aortic Stenosis

Question 1

What are the three causes of Aortic Stenosis?

Answer 1

Congenital, Degenerative, Rheumatic

Question 2

What are the three types of Congenital causes?

Answer 2

Subvalvular, Valvular due to Bicuspid AOV, Supravalvular

Question 3

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

Answer 3

Aortic Coarctation

Question 4

The resistance that the ventricles must overcome while ejecting blood

Answer 4

Afterload

Question 5

What worsens as AS progresses?

Answer 5

Concentric Left Ventricular Hypertrophy

Question 6

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

Answer 6

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

Question 7

What 3 things determine Afterload?

Answer 7

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

Question 8

2 other conditions that can increase afterload?

Answer 8

Renal Artery Stenosis

Coarctation of Aorta

Question 9

Force-Velocity Relationship

Answer 9

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

Question 10

Velocity

Answer 10

The rate at which the fibers shorten during systole.

Question 11

AS main etiologies

Answer 11

Degenerative
Congenital
Rheumatic

Question 12

Degenerative

Answer 12

AKA senile. Degenerative calcification most common cause

65-70 yrs of age

Question 13

Congenital

Answer 13

Bicuspid Valve, Subaortic membrane, supravalvular coarctation

Question 14

Unlikely to see Rheumatic Aortic disease without…….

Answer 14

Mitral Stenosis cause by Rheumatic fever as well

Question 15

Raphe

Answer 15

Underdeveloped cusp, will have one larger leaflet and one smaller

Question 16

Sigmoid Septum

Answer 16

Thickening before the AOV. Common in older population.

Question 17

Uni-Cuspid

Answer 17

Opens with a doming motion, single orifice with teardrop appearance

Question 18

Cross sectional area x TVI=

Answer 18

Stroke Volume

Question 19

Color M-Mode is superior in assessing

Answer 19

width of the jet

Question 20

Echo Features in Degenerative/ Rheumatic

Answer 20

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

Question 21

When are AS symptoms seen?

Answer 21

Often not until AS is moderate to severe

Question 22

Symptoms of AS include:

Answer 22

DOE
Chest Pain
Possible exertional syncope
Heart Failure

Question 23

Murmur Heard

Answer 23

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

Question 24

Sclerotic vs Stenotic

Answer 24

Sclerotic- cusps are calcified

Stenotic- flow is obstructed

Question 25

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

Answer 25

underestimate, overestimate

Question 26

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

Answer 26

overestimate, underestimate

Question 27

SV x VTI=

Answer 27

CSA

Question 28

M-Mode of Bicuspid AOV

Answer 28

Eccentric Closure Line

Question 29

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

Answer 29

2-D

Question 30

Malformation of leaflet and doming may be seen in ________

Answer 30

Early Systole

Question 31

Diastolic Doming may be present if __________

Answer 31

AOV prolapse

Question 32

Characteristic of Bicuspid AOV

Answer 32

Football or Cat Eye shape in Systole

Question 33

Results and Complications of AS

Answer 33

LV pressure overload | Concentric LV Hypertrophy

Question 34

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

Answer 34

An Increase in LVEDP

Question 35

Increased Risk For?

Answer 35

Infective Endocarditis Embolic Events Serious Arrythmia Sudden Death

Question 36

Importance of assessing LV size and fx?

Answer 36

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

Question 37

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

Answer 37

Color Doppler

Question 38

What is the preferred AVA method?

Answer 38

VTI Method

Question 39

Use PLAX view in early-mid systole to determine

Answer 39

LVOT diameter | 0.5-1.0 cm from cusp

Question 40

Pitfalls of AVA calculations

Answer 40

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

Question 41

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

Answer 41

16-36 mmHg

Question 42

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

Answer 42

36-64 mmHg

Question 43

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

Answer 43

> 64 mmHg

Question 44

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

Answer 44

< 30 mmHg

Question 45

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

Answer 45

30-50 mmHg

Question 46

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

Answer 46

> 50 mmHg

Question 47

What is the AS gradient criteria for peak jet velocity?

Answer 47

> 4 m/s

Question 48

What is the normal valve area?

Answer 48

> 3-5 cm squared

Question 49

What is considered mild on valve area?

Answer 49

> 1.5 cm squared

Question 50

What is considered moderate on valve area?

Answer 50

1.1- 1.5 cm squared

Question 51

What is considered mild on valve area?

Answer 51

>1.0 cm squared

Question 52

The AOV planimetry is taken when?

Answer 52

Early Systole