aortic stenosis and regurg Flashcards
2 possible pathologies leading to A stenosis
- bicuspid valve
- degenerative
- calcification or rheum
what is the mech of problems with stenosis
- outflow obstruction
- pressure hypertrophy, diastolic dysfunction, ischemia
- Sx
- death
what is pressure hypertrophy
LV pressure overload induces genes that promote concentric hypetrophy - big wall
- end up with muscle bound heart that can’t pump forward properly
what are important points of progresson in A stenosis
- 50% reducdtion in orifice leads to minimal gradient
- beyond this there are exponential increases
- variable between people
3 clinical manifestation
- angina pectoris
- syncope
- dyspnea
2 parts of angina pectoris
- low supply
- endocardial compression
- assoc. CAD - high demand
- LV hypertrophy
- myocardial o2
- wall stress
what is syncope
- classically exertional
- may also be from an arrythmia
what is dyspnea
- LV hypertrophy
- diastolic dysfunction - progressive LV dilatiation and contractile failure
- systolic dysfunction
signs and Sx of HF
when is sudden death
- 3% per year in asymptomatic PT
- malignant tachy or brady cardia
what is nat. Hx
long asymptomatic latent period
- onset of Sx is a bad sign
what is murmur like in stenosis worsening
as it get worse, it comes later and get harsher
what is bicuspid valve
- prone to stenosis and regurg
- assoc. with AAA
- risk for aortic dissection, not coarctation
- risk for endocarditis
5 parts of workup
- ECG
- LA enlargement, LV hyper - CXR
- post stenosic Aortic dilatation - ECHO
- thick and restricted leaflets
- gradient and vavle area can be calculated - Cath
- gradient across valve and valve area - stresst testing
- for prognosis
3 severity levels and measurments
mild - 40mmHg
what is med. mgmt
mech problem = mech Tx
- afterload reducing drugs contraindicated