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ECHO > Aortic Stenosis > Flashcards

Aortic Stenosis Flashcards

1
Q

Aortic Stenosis Etiology

A
  1. calcific/degenerative(50% start as bicuspid)
  2. rhematic (ass. w/ MS)
  3. congenital (bicuspid(1-2% of the populateion), membrane)
  4. supra and subvalvular obstructions
  5. prosthetic valve dysfunction
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2
Q

aortic stenosis

pathophysiology

A
  1. systolic pressure overload
  2. increase in LVEDP
  3. ventricular dysfunction may develop late in disease course
  4. increased risk for endocarditis
  5. aortic sclerosis
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3
Q

aortic stenosis- pathophysiology

systolic pressure overload leads to

A

LVH (increased in afterload)

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4
Q

aortic stenosis- pathophysiology

increase in LVEDP leading to

A

increased LA pressure

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5
Q

aortic stenosis-pathophysiology

increased risk for

A

endocarditis

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6
Q

aortic stenosis-pathophysiology

aortic sclerosis occers when

A

there is valvular thickening but no hemodynamic gradient

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7
Q

a secondary findings in aortic stenosis is

A

left ventricular hypertrophy

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8
Q

in aortic stenosis is pulse pressure wide or narrow

A

narrow (pulse pressure is the difference between systolic and diastolic pressure-it is wide in AI and narrow in AS)

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9
Q

aortic stenosis- physical signs

symptoms

A
  1. angina
  2. dyspenia
  3. syncope
  4. sudden death
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10
Q

aortic stenosis- physical signs

murmur

A

harsh systolic ejection murmur right upper sternal border (RUSB) crescendo-decrescendo

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11
Q

aortic stenosis- physical signs

decreased or absent

A

A2 (valve doesn’t move)

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12
Q

aortic stenosis-physical signs

decreased and delayed

A

carotid upstroke with bruit/thrill transmitted from AoV.

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13
Q

aortic stenosis

echo (valvular)

A
  1. thickened aortic leaflets
  2. decreased vvalve opening
  3. post-stenotic dilation of the aorta- thought to be caused by abnormal turbulence and wall stree (remember there is low pressure in the aorta (systolic BP) but high pressure in the LV)
  4. left ventricular hypertrophy
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14
Q

aortic stenosis- echo (valvular)

post stenotic dilation of the aorta thought to be caused by

A

abnormal turbulence and wall stress. (remember there is low pressure in the aorta (systolic BP) but high pressure in the LV)

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15
Q

aortic jet velocity(m/s)
mild
moderate
severe

A

mild- 2.6-2.9
moderate 3.0-4.0
severe >4

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16
Q

aortic stenosis mean gradient (mmHg)
mild
moderate
sevvere

A

mild- <20
moderate 20-40
severe >40

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17
Q

Aortic stenosis AVA(cm2)
mild
moderate
severe

A

mild- >1.5
moderate- 1.0-1.5
severe <1.0

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18
Q

aortic stenosis indexed AVA (cm2/m2)
mild
moderate
severe

A

mild- >.85
moderate- 0.60-0.85
severe- <0.6

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19
Q

aortic stenosisi dimensionless index (V-LVOT/V-AV)
mild
moderate
severe

A

mild- >0.50
moderate 0.25-0.50
sevre

20
Q

aortic stenosis echo (bicuspid)

A
  1. possible eccentric closure on m-mode (25% will have normal midline closure)
  2. thickened aortic leaflets (may be mild)
  3. systolic doming of LAX view
  4. bicuspid orfice in SAX view (football)
  5. check for coexisting coarctation of the aorta
  6. post stenotic dilation of aorta
  7. LVH
21
Q

aortic stenosis echo (bicuspid)

what do you so on M-mode

A

possible eccentric closure. )25% will have normal midline closure)

22
Q

aortic stenosis echpo (bicuspid)
what do you see in LAX view
SAX view

A

LAX view= systolic doming

SAX view+= bicuspid orifice (football)

23
Q

aortic stenosis echo (bicuspid)

what do you check fo?

A

coexisting coarctation of the aorta

24
Q

the best view to diagnose a bicuspid aortic valve is in the parasternal

A

short axis view- football shaped

25
Q

normal descending aortic velocity is about

26
Q

echo )fixed subvalvular)

A
  1. congenital membrane or ridge in LVOT beneath AoV
  2. early systolic closure of aortic leaflets
  3. LVH
27
Q

common symptom of aortic coarctation

A

systemic hypertenision

28
Q

which view is best for detecting subvalvular membranes

A

apical 5 chamber view (approx. 15% will grow back post surgical removial)

29
Q

what is takayasu’s arteritis?

A

also called aortic arch syndrome.
this disease occurs more in young women from asia.
there is fibrosis od the arch and descending aorta of unknown etiology.
in advanced states multiple coarctations may occur (look for suprevalvular aortic stenosis)

30
Q

echo (supravalvular)

A
  • most rare
  • discrete narrowing of aortic root or ascending aorta
  • LVH
31
Q

aortic stenosis doopler

A
  • use PEDOF probe and multiple windows ( suprasternal, apical, right parasternal)
  • increased velocities and turbulence at level of obstruction (valvular, subvalvular, supravalvular)
  • measure peak and mean gradients (take the highest)
  • use continuity equation for valve area if possible
  • use pulsed/color flow Doppler to locate level of obstruction.
32
Q

aortic stenosis Doppler

what correlates btter. mean Doppler and cath gradients or peak vs peak to peak.

A

mean Doppler and cath gradients correlate better then peak vs. peak to peak.

33
Q

patients BP= 110/84. aortic velocity is 5m/sec. peak LV pressure inthis patiemt is?

A

210
add the ao gradient (100mmHg if the velocity is 5m/sec) to the systolic BP.
SBP + LV/AO gradient
110+100(5)=210mmHg

34
Q

the normal aortic valve area is

35
Q 
aortic valve area
normal
mild
mod
severe
A

normal= 3-4cm sq
mild= >1.5cm sq
mod= 1.5-1.0cm sq
severe <1.0cm sq

36
Q

continunity equation

A

flow 2= flow1
area2 X V2 = area1 X V1
Area 2= area1 X V1/V2

37
Q

given
V1= 1m/sec (obtained from with PW Doppler sampling in the LVOT from the apex)
V2= 3.5m/sec (obtained with either CW or HiPRF Doppler)
A1= can be calculated as pir sq. the diameter was 2cm as measured on the long axis parasternal two chamber view during systole at the bases of the aortic valve cusps.
calculate A2

A

flow 2= flow1
area2 X V2 = area1 X V1
Area 2= area1 X V1/V2

A2= 3.14 X 1/ 3.5

3.14/3.5

aortic valve area =.9cm sq

38
Q

VTI works better in what type of patients?

A

patients with poor LV function and when moderate to severe AI is present than peak velocities.

39
Q

using the continunity equation when would the severeity of AS be underestimated?

A

LVOT measured too large.

40
Q

When do ypou measure LVOT in thwe continuity equation?

A

measure LVOT during systole at the leaflets in sertion leavel. (Same aplace as sample position for PW Doppler.)

41
Q

Aortic Valve Dimensionless Index

A

(DI) is a ration of the LVOT and AS velocities. or VTI.
When the LVOT cannot be accurately measured, or in the setting of LV dysfuntion, using this ratio may help evaluate the severeity of AS.

42
Q

Aortic Valve Dimensionless Index equation

A

DI= LVOT vel (VTI)/ AS vel (VTI)

43
Q

when would you use the Aortic Valve SDimensionless Index?

A
  1. LVOT cannot be accurately measured

2. LV dysfunction

44
Q

Aortic Valve Dimensionless Index
mild=
mod=
severe=

A

mild= >.50
mod= .25-.50
severe=

45
Q

Aortic stenosis in the cath lab.

which pressure is obtained during Doppler?

A

peak or peak instantaneous (for AS it’s the highest gradient anytime during systole)

46
Q

which is higher?

echo gradients or cath gradients?

A

echo gradients are higher. ( peak instantaneous vs. peak to peak)

47
Q

What do you look for when evalusting aortic stenosis?

A
  1. look at Vakve Area
  2. look at max gradient (if valve areas are equal
  3. look at wall thickness (evidence of LVH)

ECHO (12 decks)

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