Aortic valve disease Flashcards
causes of aortic valve leaflet disease
rheumatic heart dx endocarditis bicuspid aortic valve trauma myxomatous degeneration ankylosing spondylitis acromegaly medications (fenfluramine-phentermine)
Ascending aorta or aortic root disease etiology
hypertension, aortitis (syphilis) ankylosing spondylitis dissecting aneurysm Marfans more than ehler's danlos inflammatory bowel dx reactive arthritis marfan's syndrome autosomal polcystic kidney disease
Male patient <40 yrs and swollen ankles and chronic low back pain and osteopenia and red eyes, diagnosis for his aortic regurgitation is from?
ankylosing spondylitis.
From aortitis
when do we see syphilic aortitis?
15-30 yrs and late stage syphilis or at least tertiary syphilis (which is rare)
SLE and libman sacks endocarditis can cause aortic regurg but not
aortic root dilation.
what do we see as a complication of prosthetic heart valves?
hemolytic anemia
can see elevated LDh and anemia and dark urine, fatigue, juandice or new or changing heart murmur.
peripheral smear may show schistocytes
how to treat hemolytic anemia from prosthetic valve
ORAL or iv iron.
pts with prosthetic AR with paravalvular leak will need
Valve replacement
GI complication of untreated aortic stenosis
see colonic angiodysplasia from stimulation VEGF as a result of low factor 8
can get GI bleeding
triad of severe aortic stenosis
angina, dypsnea on exertion, dizziness and syncope
late peaking systolic murmur on exam and soft S2
parvus et tardus (diminished arterial pulses)
severe aortic stenosis
TTE for severe aortic stenosis
<0.7cm2, mean gradient >40 mm
why is a cardiac catherization necessary in evaluation and replacement of aortic valve dx for aortic stenosis
because prefer surgical valve replacement in operative candidates
About 40% of those pts require concurrent CABG
aortic valve replacement should be for pts who have severe AR
in symptomatic pts (SOB, decreased exercise tolerance)
asymptomatic pts who have abnormal TTE findings:
EF<50% and or a dilated left ventricle with either end-diastolic size>75 mm or end systolic size >55 mm)
in chronic severe aortic regurgitation that is symptomatic what do you do?
AV replacement
in chronic severe aortic regurgitation that has EF <50%
AV replacement
If chronic severe aortic regurgitation has EF of 55% but shows a dilated left ventricle with LV systolic size >55mm or a LV diastolic size >75 mm on echo?
aortic valve replacement
End diastolic valve size >75 mm or end systolic size >55 means it’s really dilated LV and needs to be replaced
if there is no indication to get aortic valve replaced in chronic severe aortic valve regurgitation, how often do you get echocardiograms?
clinical exam and TTE at 6-12 months
if there is mild aortic regurgitation, the there only needs to be a yearly evaluation and repeat echo every
2-3 years.
no formal guidelines for moderate AR but suspect reevaluate every 6-12 months with echo
people who have severe aortic valve regurgitation who have left ventricular dysfunction and are not surgical candidates should get?
vasodilators like ACEi or nifedipine
AR symptomatic pts who are awaiting surgery should get:
intense medical therapy with digoxin, diuretics, vasodilators to help decrease CHF prior to surgery
aortic regurgitation murmurs are best heard when
pt is sitting up and leaning forward and holding their breath to full expiration with the diaphragm of the stethoscope is placed along the left sternal border at the 3rd or 4th intercostal space
mild aortic stenosis follow up?
TTE every 3-5 years
moderate aortic stenosis follow up
TTE every 1-2 years
severe aortic stenosis follow up?
every 6 to 12 months
aortic stenosis should have sooner follow up if they have
new signs or symptoms of worsening AS like chest pain, dyspnea, lower extremity edema and lightheadedness and syncope
mild aortic regurgitation surveillance interval?
TTE every 3-5 years
moderate aortic regurgitation surveillance interval?
TTE every 1-2 years
severe mild aortic regurgitation surveillance interval?
TTE every 6 to 12 months
