Aortic Valve Disease Flashcards
List the causes of aortic stenosis
age over 65 - degenerative calcification of aortic valve
age under 65 - bicuspid aortic valve (most common), Turner’s syndrome, William’s syndrome, HOCM
Type of murmur in aortic stenosis and where does it radiate to?
ejection systolic murmur radiating to carotids
How can you tell if a murmur is systolic?
feel pulse and if murmur is same time as pulse it is systolic
Exam findings for aortic stenosis
ejection systolic murmur radiating to carotids
narrow pulse pressure
slow rising pulse
soft s2
Valve replacement indications
symptomatic OR valvular gradient >40
If patient is not fit enough for valve replacement
balloon valvulopasty OR TAVI (transcatheter aortic valve implantation)
Causes of aortic regurgitation
valve disease - bicuspid aortic valve, rheumatic heart disease, infective endocarditis
aortic root disease - marfans, ehlers danlos, aortic dissection
Exam findings for aortic regurgitation
early diastolic murmur
collapsing pulse
wide pulse pressure
de Musset’s (head bobbing)
Quinke’s (nailbed pulsation)
Two types of origin for biological valves
bovine OR porcine
Most common mechanical valve
bileaflet valve
Medication following biological valve replacement
warfarin for first 3 months
low dose aspirin long term (lifelong)
Disadvantage of biological valves
susceptible to degeneration and calcification
hence used in older patients with fewer remaining years of life (>65yrs for aortic, >70yrs for mitral)
Advantage of mechanical valve replacement
hard wearing - less likely to need replacement or repeat surgery
Disadvantage of mechanical valve replacement
increased risk of thrombosis - lifelong warfarin is required
INR target for aortic valve replacement
INR 3.0
INR target for mitral valve replacement
INR 3.5
