Aortic valve disease Flashcards
Most common cause of aortic regurg in US is?
Other causes?
-Congenital bicuspid valve
- degeneration of aging
- rheumatic fever
- endocarditis-staphylococcal
- degeneration of bioprosthesis
- dilation of aortic root
- marfans syndrome
Pathophys of Aortic regurg?
-blood ejected by the LV regurgs=
=inc LVEDV –> hyptrophy and LV dilation
=LVEF normal to high (includes normal EF plus) and SV is als normal to high
hypertrophy–>dilation–>HF
Aortic regurg
-History:
- underlying disease is nice to have
- long illness -up to 60 years of illness
- asymptomatic until LV dysfunction begins 40s-50s
- DYSPNEA
- nonspecific chest pain
- palpitations
- angina pectoris
Aortic regurg
-Physical exam:
- Wide pulse pressure - up to 100mmHg
- LV apex diffuse, hyperdynamic and displaced left and downward
- S1 and S2 normal to soft
- S3 common with LV dysfunction
- Korotkof sounds persist to 0
- aortic efection sounds
- Diastolic murmur = always pathologic –> the longer the murmur the worse the regurg
- Austin flint murmur- mid to late diastolic rumble of functional Mitral Stenosis (mitral valve may be normal)
Other signs of Aortic regurg on physical exam:
- austin flint
- corrigan pulse (collapsing or “water hammer pulse”
- de Musset’s sign - head bobs with each systole
- Duroziez sign -to and fro bruit in femoral artery
- Hills sign - popliteal BP>brachial by 60mmHG
- Mullers sign-systolic pulsations in uvula
- Quickes pulse-visible of bluish nailbed in systole/blanching in diastole
- traubes sign - pistol shot sound
Diagnostic tool for aortic regurg?
echocardiography-fluttering of anterior mitral valve leaflet in diastole
Aortic regurg -tx?
- usually a long clinical course
- want to reduce high systemic diastolic pressure (AVOID BETA BLOCKERS)
- vasodilators (ACEI, and dihydropyridine calcium channel blockers (reduce afterload, improve LV ejection)
- Valve replacement - only for symptomatic patients
Drug of choice for aortic regurg?
-ACEI
prevalence of Aortic stenosis?
<1% of total population
Aortic stenosis -onset/prognosis:
- long latent period without symptoms
- prognosis is poor when symptoms develop: angina or syncope and HF in 50%
3 symptoms of aortic stenosis:
angina
syncope
-HF
cuase of aortic stenosis:
congeital or degeneration
pathophys of aortic stenosis:
- obstruction to outflow= pressure gradient across the valve
- inc LVEDP inc wall stress = LV hypertrophy
- reduced sub-endocardial perfusion
Aortic stenosis - history:
- may have history of rheumatic fever
- often asymptomatic for decades
- Angina pectoris
- syncope - secondary to exertion
- GI bleed - colon angiodysplasia
- HF is a late sign
Exertonal syncope think:
aortic stenosis
Aortic stenosis: Physical exam:
- takes longer to push blood out through the narrow arotic valve that doesnt move=arterial pulses are small and late
- carotids display a systolic THRILL (coarse vibration)
- carotids peak after LV apical impulse
- Apical impulse= sustained lift-moves left and downward in HF
Aortic stenosis - heart sounds:
-S1 normal to soft
-S2 varies - often single
A2 may be softened by immobility of valve
P2can be buried in the prolonged murmur
-may have paradoxical split A2 follows P2 if LV failing
Aortic stenosis murmurs:
- heard best at the base of the haert
- crescendo/decerscendo is loud and peaks late (DIAMOND SHAPED)
- commonly radiates to carotids, occasionally at apex
- may have diastolic murmur of AR
Aortic stenosis- ECG
same as if you were to see hypertrophy
-dont do stress testin!
Aortic stenosis treatment:
1) drugs little use:
- diuretics reduce fluids burden but may cause orthostasis by lowering cardiac output
- digitalis glycosides may help improve LV performance
- beta blckers must be avoided
2) a fib must be converted bc we need the atrial kick
3) VALVE REPLACEMENT!!!!!!!!
