Aortic valve disease Flashcards
Aortic stenosis causes
Senile calcification (most common)
Congenital
Rheumatic heart disease
Aortic stenosis presentation
Elderly person with chest pain, exertional dyspnoea
Classic triad of: angina, syncope, heart failure
Aortic stenosis signs
Slow rising pulse
Diminished delayed carotid upstroke
Aortic thrill
Ejection systolic murmur
Normal S1
A2 quiet or delayed in severe stenosis
Aortic stenosis ECG
LVH and LBBB p-mitrale LAD Poor R wave progression Complete AV block with calcified ring
Aortic stenosis CXR
LVH
Calcified aortic valve
Post-stenotic dilatation of ascending aorta
Aortic stenosis tests
ECG
CXR
Echo is diagnostic
Doppler echo
Aortic stenosis Doppler echo findings
Severe stenosis if gradient across valve ≥40 and valve area <1cm^2
If aortic jet velocity >4m/s, risk of complications increased
Aortic stenosis management
Surgery if moderate-severe, even if asymptomatic
TAVI if pt not medically fit for surgery
What is aortic sclerosis
Senile degeneration of valve
Ejection systolic murmur but no carotid radiation or pulse abnormality
Aortic regurgitation acute causes
Infective endocarditis
Ascending aortic dissection
Chest trauma
Aortic regurgitation chronic causes
Congenital Connective tissue disorders Rheum conditions (SLE, RA, Takayasu's, seronegatives) Rheumatic fever HT
Aortic regurgitation symptoms
Exertional dyspnoea
Orthopnoea
Palpitations
Angina
Syncope
Aortic regurgitation signs
Water-hammer pulse
Corrigan's sign de Musset's sign Quincke's sign Duroziez's sign Traube's sign Austin-Flint murmur in severe
What is Corrigan’s sign
Carotid pulsation
What is de Musset’s sign
Head nodding with each heart beat
What is Quincke’s sign
Capillary pulsations in nail beds
What is Duroziez’s sign
Finger compressing femoral artery in groin 2cm proximal to stethoscope gives systolic murmur as blood flows backwards
What is Traube’s sign
Pistol shot sound over femoral arteries
Aortic regurgitation tests
ECG shows LVH
CXR shows cardiomegaly, dilated ascending aorta, pulmonary oedema
Echo is diagnostic
Aortic regurgitation management
Reduce systolic HT
Echo every 6-12mths to monitor
Surgery if: Severe AR with enlarged ascending aorta Increasing symptoms Enlarging/deteriorating LV function IE refractory to medical therapy
Aortic regurgitation poor post-op survival indicators
Ejection fraction <50%
NYHA Class III/IV
CCF>12mths
