aortic stenosis and regurg Flashcards
normal aortic valve area (aaa)
3 cm2
aortic stenosis often leads to what type of hypertrophy?
pressure hypertrophy - concentric
and diastolic dysfunction
symptoms of aortic stenosis happen when
demand on heart exceeds ability to increase stroke volume
acquired aortic stenosis happens in which decade of life
5th decade
congenital bicuspid valves degenerate in which decade of life
6th decade
tricuspid aortic valve pathology associated with which decade of life
late - disorder of elderly
exponential increase above ? % result in exponential gradient increase across aortic valve
50% valve orifice reduction (1.5 cm2)
clinical manifestations of aortic stenosis
SAD
- syncope - exertional
- angina
- dyspnea -
sudden death due to aortic stenosis often the result of
malignant tachy or brady arrythmias
natural history of aortic stenosis
follow people until symptoms arise
as the aortic stenosis gets worse - the murmur starts to peak
later - obliterates S2
bicuspid aortic valve is a risk factor for
aortic dissection
bicuspid aortic valve is rarely associated with
aortic coarctation
majority of coarctations are in the setting of
bicuspid aortic valve
Findings on ECG in aortic stenosis
LA enlargement and LV hypertrophy
what happens if you give someone with aortic stenosis an ACEi - to reduce afterload -
can cause syncope
aortic regurgitation associated with what 3 etiologies
- disease valve cusp
- diseased aortic root - CTD
- Acute pathology - dissection/endocarditis
in acute aortic regurgitation what happens to left ventricle and left atrium
- left ventricle filling pressure goes up
- left atrium backs up- congestion in lungs -
chronic aortic regurg leads to what changes in left ventricle
- eccentric hypertrophy
- large stroke volume
- NO pulmonary congestion
chronic severe aortic regurg leads to
Systolic dysfunction
reduced ejection fraction
in acute aortic regurgitation what happens to forward output
falls
in chronic aortic regurgitation what happens to forward output
remains normal
in chronic severe/decompensated aortic regurgitation what happens to forward output
falls- reducing stroke volume
high pitched early diastolic murmur
- sash radiation
- associated with S3
is. …
aortic regurg
ECG on someone with aortic regurg will always show
LVH
see cardiomegaly on xray
what should you avoid in medical management of aortic regurg
bradycardia -
anyone who is symptomatic with aortic regurg
should be operated on
if someone is asymptomatic, with normal ejection fraction but severe ventricular dilatation
very probably they need Sx management
