Aortic Valve Disease Flashcards

1
Q

What is a heart murmur?

A

a sound produced to turbulent blood flow within the heart

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2
Q

What is the first heart sound produced by?

A

The closure of the mitral and tricuspid valves

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3
Q

What is the second heart sound produced by?

A

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.

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4
Q

What is aortic stenosis?

A

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.

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5
Q

Give the three main causes of aortic valve stenosis:

A

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

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6
Q

What causes calcific aortic valvular disease?

A

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

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7
Q

What is the cause of a bicuspid aortic valve?

A

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.

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8
Q

Describe the pathophysiology of aortic valve stenosis: (4)

A

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

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9
Q

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

A

true

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10
Q

When in an aortic stenosis murmur the loudest?

A
  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
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11
Q

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

A

2-3

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12
Q

Describe how pulse presents in aortic valve stenosis:

A

carotid pulse has a small volume and is slow-rising

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13
Q

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

A

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

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14
Q

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

A

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

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15
Q

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

A

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

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16
Q

How is aortic valve stenosis treated?

A

Aortic valve replacement

17
Q

What type of murmur is aortic regurgitation associated with?

A

An early diastolic murmur heard loudest as the left sternal edge

17
Q

What is a sign of moderate/severe aortic stenosis?

A

Reduced or absent S2 sound

18
Q

What is aortic regurgitation?

A

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

19
Q

Give 6 causes of aortic regurgitation:

A

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

20
Q

Describe the pathophysiology of aortic regurgitation:

A

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

21
Q

What are 9 clinical features of aortic regurgitation?

A
  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
22
Q

What is Quincke’s sign?

A

Capillary pulsation in nail beds

23
Q

What is de Musset’s sign?

A

head nodding with every heart beat

24
Q

What is Duroziez’s sign?

A

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

24
Q

What are pistol shot femorals?

A

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

25
Q

What is hyperdynamic circulation?

A

abnormally increased circulatory volume

26
Q

What is the Austin Flint murmur?

A

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.

27
Q

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

A

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

28
Q

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

A

beta blockers

29
Q

What is the main treatment for aortic regurgitation?

A

valve replacement surgery