Aortic valve disease

Question 1

causes of aortic valve leaflet disease

Answer 1

rheumatic heart dx
endocarditis
bicuspid aortic valve 
trauma
myxomatous degeneration
ankylosing spondylitis
acromegaly
medications (fenfluramine-phentermine)

Question 2

Ascending aorta or aortic root disease etiology

Answer 2

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

Question 3

Male patient <40 yrs and swollen ankles and chronic low back pain and osteopenia and red eyes, diagnosis for his aortic regurgitation is from?

Answer 3

ankylosing spondylitis.

From aortitis

Question 4

when do we see syphilic aortitis?

Answer 4

15-30 yrs and late stage syphilis or at least tertiary syphilis (which is rare)

Question 5

SLE and libman sacks endocarditis can cause aortic regurg but not

Answer 5

aortic root dilation.

Question 6

what do we see as a complication of prosthetic heart valves?

Answer 6

hemolytic anemia

can see elevated LDh and anemia and dark urine, fatigue, juandice or new or changing heart murmur.

peripheral smear may show schistocytes

Question 7

how to treat hemolytic anemia from prosthetic valve

Answer 7

ORAL or iv iron.

Question 8

pts with prosthetic AR with paravalvular leak will need

Answer 8

Valve replacement

Question 9

GI complication of untreated aortic stenosis

Answer 9

see colonic angiodysplasia from stimulation VEGF as a result of low factor 8

can get GI bleeding

Question 10

triad of severe aortic stenosis

Answer 10

angina, dypsnea on exertion, dizziness and syncope

Question 11

late peaking systolic murmur on exam and soft S2

parvus et tardus (diminished arterial pulses)

Answer 11

severe aortic stenosis

Question 12

TTE for severe aortic stenosis

Answer 12

<0.7cm2, mean gradient >40 mm

Question 13

why is a cardiac catherization necessary in evaluation and replacement of aortic valve dx for aortic stenosis

Answer 13

because prefer surgical valve replacement in operative candidates

About 40% of those pts require concurrent CABG

Question 14

aortic valve replacement should be for pts who have severe AR

Answer 14

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)

Question 15

in chronic severe aortic regurgitation that is symptomatic what do you do?

Answer 15

AV replacement

Question 16

in chronic severe aortic regurgitation that has EF <50%

Answer 16

AV replacement

Question 17

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?

Answer 17

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

Question 18

if there is no indication to get aortic valve replaced in chronic severe aortic valve regurgitation, how often do you get echocardiograms?

Answer 18

clinical exam and TTE at 6-12 months

Question 19

if there is mild aortic regurgitation, the there only needs to be a yearly evaluation and repeat echo every

Answer 19

2-3 years.

no formal guidelines for moderate AR but suspect reevaluate every 6-12 months with echo

Question 20

people who have severe aortic valve regurgitation who have left ventricular dysfunction and are not surgical candidates should get?

Answer 20

vasodilators like ACEi or nifedipine

Question 21

AR symptomatic pts who are awaiting surgery should get:

Answer 21

intense medical therapy with digoxin, diuretics, vasodilators to help decrease CHF prior to surgery

Question 22

aortic regurgitation murmurs are best heard when

Answer 22

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

Question 23

mild aortic stenosis follow up?

Answer 23

TTE every 3-5 years

Question 24

moderate aortic stenosis follow up

Answer 24

TTE every 1-2 years

Question 25

severe aortic stenosis follow up?

Answer 25

every 6 to 12 months

Question 26

aortic stenosis should have sooner follow up if they have

Answer 26

new signs or symptoms of worsening AS like chest pain, dyspnea, lower extremity edema and lightheadedness and syncope

Question 27

mild aortic regurgitation surveillance interval?

Answer 27

TTE every 3-5 years

Question 28

moderate aortic regurgitation surveillance interval?

Answer 28

TTE every 1-2 years

Question 29

severe mild aortic regurgitation surveillance interval?

Answer 29

TTE every 6 to 12 months