Aortic Valve Disease

Question 1

What is a heart murmur?

Answer 1

a sound produced to turbulent blood flow within the heart

Question 2

What is the first heart sound produced by?

Answer 2

The closure of the mitral and tricuspid valves

Question 3

What is the second heart sound produced by?

Answer 3

The second heart sound (S2) is caused by the closure of aortic and pulmonary valves. It marks the end of ventricular systole and the start of diastole.

Question 4

What is aortic stenosis?

Answer 4

Refers to a tightening of the aortic valve at the origin of the aorta

Aortic stenosis is associated with an ejection systolic murmur heard loudest over the aortic valve. The murmur is described as having a ‘crescendo-decrescendo’ quality (it appears as diamond-shaped on a phonogram). The murmur of aortic stenosis commonly radiates to the carotid arteries.

Question 5

Give the three main causes of aortic valve stenosis:

Answer 5

1) calcific aortic valvular disease
2) bicuspid aortic valve
3) rheumatic fever

Question 6

What causes calcific aortic valvular disease?

Answer 6

an inflammatory process involving macrophages and T lymphocytes, thickening the valve endothelium causing fibrosis and calcification
-reducing systolic opening

Question 7

What is the cause of a bicuspid aortic valve?

Answer 7

congenital
Congenital abnormality of the aortic valve: the aortic valve is normally composed of three cusps (known as a tricuspid valve), but in some cases, individuals have only two cusps (known as a bicuspid valve) which predisposes them to the development of AS as well as aortic regurgitation.

Question 8

Describe the pathophysiology of aortic valve stenosis: (4)

Answer 8

1) obstructed LV emptying leads to increased LV pressure and compensatory LV hypertrophy
2) in exercise, when cardiac demand increases, the cardiac output struggles to increase against the obstruction
3) this causes BP to fall and coronary ischaemia
4) ischaemia causes the myocardium to fail and for cardiac arrhythmia to develop

Question 9

True or false: symptoms of aortic valve stenosis only arise until the disease is severe

Answer 9

true

Question 10

When in an aortic stenosis murmur the loudest?

Answer 10

1. Ejection systolic murmur heard loudest over the aortic area
2. Radiates to carotid arteries
3. Loudest on expiration and when the patient is sitting forward

Question 11

Fill the gap: on average, death occurs within - years in patients with aortic valve stenosis if there has been no surgical intervention

Answer 11

2-3

Question 12

Describe how pulse presents in aortic valve stenosis:

Answer 12

carotid pulse has a small volume and is slow-rising

Question 13

What auscultation finding would help to confirm a diagnosis of aortic valve stenosis?

Answer 13

Ejection systolic murmur that follows a crescendo-decresendo pattern
(can radiate into the carotid arteries)

Question 14

What finding on a CXR would help to confirm a diagnosis of aortic stenosis?

Answer 14

Prominent , dilated, ascending aorta
(as a result of turbulent flow)

Question 15

What echocardiogram findings would help confirm a diagnosis of aortic valve stenosis?

Answer 15

thickened, calcified and immobile aortic valve cusps and the presence of LV hypertrophy

Question 16

How is aortic valve stenosis treated?

Answer 16

Aortic valve replacement

Question 17

What type of murmur is aortic regurgitation associated with?

Answer 17

An early diastolic murmur heard loudest as the left sternal edge

Question 17

What is a sign of moderate/severe aortic stenosis?

Answer 17

Reduced or absent S2 sound

Question 18

What is aortic regurgitation?

Answer 18

Occurs when there is a backflow of blood from the aorta into the left ventricle during ventricular diastole

Question 19

Give 6 causes of aortic regurgitation:

Answer 19

1) syphilis
2) endocarditis
3) Marfan’s syndrome
4) arthritis
5) rheumatic fever
6) osteogenesis imperfecta

Question 20

Describe the pathophysiology of aortic regurgitation:

Answer 20

1) reflux of blood from the aorta moves through the aortic valve into the left ventricle during diastole
2) to maintain cardiac output, the total volume of blood pumped into the aorta must increase and so the LV size must enlarge
3) the larger LV is less efficient so that demand for oxygen is greater and cardiac ischaemia develops

Question 21

What are 9 clinical features of aortic regurgitation?

Answer 21

1. LV failure
2. Angina
3. Dyspnoea
4. Bounding or collapsing pulse
5. Quicke’s sign
6. de Musset’s sign
7. Duroziez’s sign
8. pistol shot femorals
9. High pitched early diastolic murmur

Question 22

What is Quincke’s sign?

Answer 22

Capillary pulsation in nail beds

Question 23

What is de Musset’s sign?

Answer 23

head nodding with every heart beat

Question 24

What is Duroziez’s sign?

Answer 24

An audible diastolic murmur which can be heard over the femoral artery when compressed with the stethoscope

Question 24

What are pistol shot femorals?

Answer 24

sharp bangs heard on auscultation over the femoral arteries in time with each heart beat

Question 25

What is hyperdynamic circulation?

Answer 25

abnormally increased circulatory volume

Question 26

What is the Austin Flint murmur?

Answer 26

A low-pitched rumbling mid-diastolic murmur heard best at the apex.
This is caused by the regurgitated blood through the aortic valve mixing with blood from the left atrium, during atrial contraction.
An Austin Flint murmur is a sign of severe aortic regurgitation.

Question 27

Give 3 investigations for aortic regurgitation and their associated positive findings:

Answer 27

1) chest x-ray -> LV enlargement and dilation of the ascending aorta
2) ECG -> signs of LV hypertrophy
3) echocardiogram -> dilated LV and enlarged aortic root

Question 28

What drug may slow aortic dilation in Marfan’s syndrome?

Answer 28

beta blockers

Question 29

What is the main treatment for aortic regurgitation?

Answer 29

valve replacement surgery