Aortic Valve Disease

Question 1

What does aortic stenosis impair?

Answer 1

Left ventricular outflow

Question 2

Aortic stenosis symptoms include? (3)

Answer 2

Angina
Syncope
Dyspnea

Question 3

When does systolic murmur peak for aortic stenosis?

Answer 3

Mid to late systole

Question 4

What diagnostic testing is the most useful that confirms and quantifies the severity of stenosis?

Answer 4

Echocardiography

Question 5

Aortic regurgitation may present acutely in the setting of?

Answer 5

Endocarditis

Question 6

How many pocket like cusps are on the aortic valve?

Answer 6

Semilunar valve that includes 3 pocket like cusps of normal equal size

Question 7

When does the normal aortic valve open?

Answer 7

Completely during systole.

Question 8

What is the most common cause of LV outflow obstruction?

Answer 8

Valvular aortic stenosis (AS)

Question 9

What accounts for two thirds of aortic valve replacements for AS in patients younger than 70?

Answer 9

Bicuspid valve in the Aortic valve

Question 10

What is the main diagnosis of patients with AS after age 70?

Answer 10

Calcific degeneration

Question 11

When does rheumatic AS present between for age?

Answer 11

30 and 50 years old

Question 12

Imaging in a aortic dilation case with patients with a bicuspid aortic valve, what is the measurement recommended for a surgical center?

Answer 12

> 4.5 cm

Question 13

Approximately how many people who have angina with severe AS also have significant coronary artery disease?

Answer 13

one half

Question 14

What are other clinical manifestations of AS? (3)

Answer 14

GI bleeding
Embolic events (stroke)
Infective endocarditis

Question 15

What are the 3 key focus areas in a physical examination for AS?

Answer 15

Evaluation of the carotid artery
Auscultation of the murmur
Second heart sound

Question 16

What can identify the location of the aortic outflow obstruction, estimate the severity of valvular obstruction and provide information about LV function?

Answer 16

Transthoracic echocardiogram

Question 17

Most common ECG findings in late stage AS? (2)

Answer 17

LVH >80% and LA hypertrophy

Question 18

Coronary angiography is necessary to identify what in all patients older than what that require AVR?

Answer 18

CAD
older than 35

Question 19

when there is inconclusive information for AS, what is used to discover hemodynamic measurements?

Answer 19

Left and right heart cath to obtain pressure gradients and measure cardiac output

Question 20

Aortic root replacement is considered when the diameter is?

Answer 20

> 5.1 to 5.5 cm or over 4.5 if AVR is indicated

Question 21

When can AVR be delayed until?

Answer 21

Symptoms develop

Question 22

When can TAVR be used to replace AVR (3)

Answer 22

For inoperable
high risk
intermediate surgical risk patients

Question 23

What does Aortic valve regurgitation (AR) result in? (2)

Answer 23

Impaired cardiac output
Volume overload of the LV

Question 24

What needs to be distinct of AR because it informs etiologies, associated diseases, prognosis, and treatment?

Answer 24

Acute or chronic forms of AR

Question 25

What is responsible for approximately 50% of cases of AR?

Answer 25

Aortic root disease

Question 26

What is the mortality rates of people with AR with symptoms?

Answer 26

10-20%

Question 27

What is the percentage of patients who died or progressed to LV dysfunction without symptoms?

Answer 27

25%

Question 28

Patients with acute AR usually appear? (5)

Answer 28

Severely ill Tachycardia Hypotension Vasoconstriction Pulmonary Edema

Question 29

When acute volume overload is poorly tolerated in the LV, it results in? (5)

Answer 29

Increased LA pressure Pulmonary capillary wedge pressures, pulmonary edema Forward cardiac output reduction Sinus Tachycardia

Question 30

Aortic root disease causes the murmur to be louder to what location?

Answer 30

Right of the sternum

Question 31

Hemodynamic tracings in severe AR show? (2)

Answer 31

A wide pulse pressure and elevated LV end-diastolic pressure.

Question 32

What does aortic root angiography provide? (2)

Answer 32

Assessment of severity Qantitative calculations

Question 33

Surgery is strongly recommended in asymptomatic patients with AR who have a depressed LV EF of?

Answer 33

<50%