aortic stenosis and regurg Flashcards

1
Q

2 possible pathologies leading to A stenosis

A
  1. bicuspid valve
  2. degenerative
    - calcification or rheum
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2
Q

what is the mech of problems with stenosis

A
  1. outflow obstruction
  2. pressure hypertrophy, diastolic dysfunction, ischemia
  3. Sx
  4. death
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3
Q

what is pressure hypertrophy

A

LV pressure overload induces genes that promote concentric hypetrophy - big wall
- end up with muscle bound heart that can’t pump forward properly

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4
Q

what are important points of progresson in A stenosis

A
  • 50% reducdtion in orifice leads to minimal gradient
  • beyond this there are exponential increases
  • variable between people
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5
Q

3 clinical manifestation

A
  1. angina pectoris
  2. syncope
  3. dyspnea
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6
Q

2 parts of angina pectoris

A
  1. low supply
    - endocardial compression
    - assoc. CAD
  2. high demand
    - LV hypertrophy
    - myocardial o2
    - wall stress
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7
Q

what is syncope

A
  • classically exertional

- may also be from an arrythmia

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8
Q

what is dyspnea

A
  1. LV hypertrophy
    - diastolic dysfunction
  2. progressive LV dilatiation and contractile failure
    - systolic dysfunction
    signs and Sx of HF
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9
Q

when is sudden death

A
  1. 3% per year in asymptomatic PT

- malignant tachy or brady cardia

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10
Q

what is nat. Hx

A

long asymptomatic latent period

- onset of Sx is a bad sign

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11
Q

what is murmur like in stenosis worsening

A

as it get worse, it comes later and get harsher

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12
Q

what is bicuspid valve

A
  • prone to stenosis and regurg
  • assoc. with AAA
  • risk for aortic dissection, not coarctation
  • risk for endocarditis
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13
Q

5 parts of workup

A
  1. ECG
    - LA enlargement, LV hyper
  2. CXR
    - post stenosic Aortic dilatation
  3. ECHO
    - thick and restricted leaflets
    - gradient and vavle area can be calculated
  4. Cath
    - gradient across valve and valve area
  5. stresst testing
    - for prognosis
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14
Q

3 severity levels and measurments

A

mild - 40mmHg

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15
Q

what is med. mgmt

A

mech problem = mech Tx

- afterload reducing drugs contraindicated

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16
Q

4 reasons stenosis important

A
  1. common
  2. major clinical implications
  3. morbid once Sx
  4. treatable
17
Q

5 common errors in stenosis

A
  1. failure to disting sclerosis from stenosis
  2. failure to diagnoe/investigate
  3. failure to act once Sx there
  4. prescribing afterload reducing agents
  5. abrupt reduction in preload/afterload
18
Q

3 possible causes of A regurg

A
  1. diseased valve cusps
    - calc, bi cusp, rhuem
  2. diseased aortic root
  3. acute patho
    - dissection, trauma, endocarditits
19
Q

what is pathophys is acute

A
  • acute Vol overload leads to high filling P
  • LV doesn’t have time to accom.
  • stroke vol goes up a bit, but not enough to deal with all the extra
  • low forward output and high L atrium pressure
20
Q

what is patho in chronic

A
  • get eccentric hypertrophy - cor bovinum
  • v. large strok vol get blood forward well
  • ejection fraction remains the same
  • can stay compensated for a long time
21
Q

what happens in decomp.

A
  • eventual LV fibrosis and systolic dysfunction
  • wall tension and pressure rises over time
  • evenutally ejection fraction falls
22
Q

what is natural Hx

A
  • asymptomic for decades
  • remodelling is asymptomaic for a while
  • then get Sx and it is bad
23
Q

3 main Sx of regurg

A
  1. palplitations - due to hyperdynamic stroke volume
  2. failure
    - dyspnea on exertion, orthopnea, fatugue
  3. angina, syncope
24
Q

what is heart sound with regurg

A

high pitched early diastolic murmur

25
Q

4 tests

A
  1. ECG - LVH
  2. CXR - megaly
  3. ECHO
  4. cath
26
Q

5 parts of med mgmt

A
  1. surveillance ECHO
  2. avoid bradycardia
  3. vigilance against endocard
  4. diuretics
  5. vasodilators
27
Q

indications for surg

A
definite
- Sx with normal ejection fraction
- Sx with mild decrease EF
v. prob
- Asx but with sever LV dilatation
probable
- severe LV systolic dysfunction
28
Q

2 common errors

A
  1. failure to monitor for asymptomatic but irreversible LV remodelling
  2. over-reliance on meds on remodellig occurs
29
Q

what is surg

A

valve replacment