Aortic Valve Disease Flashcards
How does Aortic Stenosis lead to Heart failure?
Pressure backs up in the LH causing it to hypertrophy. This increases myocardial O2 deand eventually leading to LVF
What causes Aortic Stenosis?
Degenerative disease - A slowinflammatory process thickens and calciies the cusps (senile calcification, linked to atherosclerosis)
Rheumatic disease
Congenital Bicuspid Valve
What is the symptoms of aortic stenosis?
A long time is spent asymptomatic then suddenly:
Angina - Syncope - SOBOE - Heart Failure
What is the clinical presentation of aortic stenosis?
Pulse is small and slow rising
If the Right heart fails then theres a high JVP
A low BP
A vigorous & sustained Apex Beat
LV Heave
A harsh late sound in the aortic valve that radiates to the carotids (Auscultation)
Aortic Thrill
How do we investigate aortic stenosis?
ECG - CXR - Echo - CMR
ECG - LV Strain pattern showing LVH (ST depression & T inversion)
CXR - AV calcification
Echo: AV thickening - LV function - Pressure gradient with a doppler-echo
CMR - Cusp adhesion or bicuspid
How do we treat Aortic Stenosis?
We can use meds to treat heart failure
But the valve has to be surgically replaced or repaired
How does Aortic Regurgitation progress?
The blood backs up so LV volume & perssure increases -> LVH -> increased O2 demand -> Ischaemia & LV failure`
What can cause aortic regurgitation?
Dilated Aorta due to marfan’s or hypertension and connective tissue disorders.
Also congenital bicuspid AV - Rheumatic Heart Disease - Endocarditis - Myxomatous Degeneration
What are the symptoms of aortic regurgitation?
IF it happens acutely then LV failure, cyanosis and dyspnoea
If its chronic there will be a long time without symptoms with SOBOE and eventual RVF
What is the clinical presentation of Aortic Regurgitation?
A large collapsing pulse
A wide pulse pressure
A hyperdynamic & displaced Apec Beat
A soft, early diastolic murmur on auscultation of the AV.
What would appear in an Aortic Regurgitation ECG?
An LV strain pattern of ST depression & T wave inversion. Signifying LVH
What would show up on an Aortic Regurgitation CXR?
Cardiomegaly in chronic AR
What would an Echo show us in Aortic Regurgitation?
AV thickening, prolapse, bicuspid and/or vegetations.
Also LV function, dilatation & hypertrophy.
A Doppler-Echo would show the regurgitant flow.
How can we treat Aortic Regurgitation?
Vasodilator Therapy can prolong surgery but it will have to be surgically repaired or replaced eventually
