Aortic Valve Disease Flashcards
What are the type of causes of aortic regurgitation?
- Valve abnormalities
2. Aortic root dilation
What are the valve abnormalities that can cause AR?
- IE
- Trauma
- Rheumatic fever
- Congenital disease
What are the causes of aortic root dilation that can cause AR?
- Hypertension
- Aortic dissection
- Aortitis
- Arthritides
What happens in systole?
pulmonary and aortic valve OPEN so stenosis of these affect flow of blood so SYSTOLIC MURMUR
What happens in diastole?
- pulmonary and aortic valve CLOSED so insufficiency/regurgitation pf these valves is enabling backflow of blood so DIASTOLIC MURMUR
- Opposite is true for mitral and tricupside valve because they are closed during systeole and open during diastole
What sort of murmur is aortic stenosis?
Ejection Systolic
What sort of murmur is mitral stenosis?
Mid/late diastolic
What sort of murmur is tricuspid stenosis?
Mid/late diastolic
What sort of murmur is pulmonary stenosis?
Ejection systolic
What sort of murmur is aortic regurgitation?
Early diastolic
What sort of murmur is mitral regurgitation?
pansystolic
What sort of murmur is tricuspid regurgitation?
pansystolic
What sort of murmur is pulmonary regurgitation
pansystolic
How do you remember murmurs?
PASS PAID
Pulmonary aortic stenosis systole
Pulmonary aortic insufficiency diastole
What are causes for aortic stenosis?
- Senile calcification
- Congenital (bicuspid valve, Williams syndrome)
- Rheumatic heart disease
- CKD is RF
What is the epid for aortic stenosis?
eldery person, chest pain externtion dyspnoea, syncope
What are symptoms for aortic stenosis?
- Chest pain
- Exertional dyspnoea
- Syncope
- Heart failure
- Dizziness
What are signs of aortic stenosis?
- Slow rising pulse with narrow pulse pressure
- Heaving
- Non displaced apex beat
- LV heave
- Aortic thrill
- Ejection systolic murmur
- Radiates to carotids
- May be ejection click
- Systolic, mid-to-late peaking with crescendo-decrescendo pattern and radiates to carotids
What are symptoms of AR?
- Exertional dyspnoea
- Orthopnoea
- PND
- Palpitations
- Angina
- Syncope
What are signs of AR?
- Collapsing pulse
- Wide pulse pressure
- Displaced apex beat
- High pitch early diastolic murmur
What is DDx for AS?
Hypertrophic cardiomyopathy
What is DDx for AR?
- MR
- Mitral stenosis
- Aortic stenosis
What Ix is diagnostic for AR and AS?
transthoracic echo
What would ECG show in AS?
- LVH with strain pattern
- p-mitrale
- LBBB or complete AV block
What would CXR show in AS?
LVH, calcified aortic valve
What would cardiac catheter show?
- AS: valve gradient, LV function, CAD risks,
- AR: asses severity of lesion, anatomy or aortic root, LV function, CAD
What would ECG show in AR?
LVH
What would CXR show in AR?
- cardiomegaly
- dilated asecending aorta
- pulmonary oedema
- LV dilation
What surgery is used?
valve replacement: open surgery or through transcatheter approach
What are options for valve replacement?
metallic, animal tissue
What must you be given if you have a metallic valve?
increased risk of clots, given warfarin
What is there a risk of with animal tissue valve?
risk of tissue rejection and degeneration
How do you manage severe AS?
- Transcatheter or surgical valve prosthesis
2. If not fit for surgery can use transcatheter aortic valve implantation
How do you treat AR?
- Reduce systolic HTN: Ace-I
- Echo every 6-12 month to monitor
- Surgery: when enlarged ascending aorta, increasing symptoms
When is AVR indicated?
symptomatic patient or with LV EF <50% and asymptomatic patients with sevrer AR if LV end diastolic volume >75mm or LV end-systolic volume >55mm
What are possible complications of AS?
- Acute congestive heart failure
- Sudden cardiac death in symptomatic/asympomatic patients
- Infection of prosthetic valve
What are possible complications of AR?
- Operative mortality
- CHF
- Arrhythmias
What is the prognosis of aortic valve disease?
No surgery prognosis: 2-3 survival and 1-2yr with cardiac failure in AS and AR less mortality
