Aortic Valve Disease Flashcards
What is the most common valve disease?
- Aortic stenosis
What causes aortic stenosis?
- Senile calcification
- bicuspid valve
- Williams syndrome
- Rheumatic Heart disease
What is the classic triad for AS?
- angina
- syncope
- HF
Apart from the triad, what are the other sx of AS?
- chest pain
- exertional dyspnoea
- syncope
- systemic emboli if infective endocarditis
- sudden death
What sound does AS generate?
- ejection-systolic murmur
- Heard loudest on expiration
- cresendo-decrescendo
What are the other signs of AS?
- murmur radiates to carotids
- slow rising pulse with narrow pulse pressure
What are the significant signs of AS?
- low volume pulse
- narrow pulse pressure
- slow rising carotid pulse
- undisplaced, forceful apex beat
- soft/absent A2
- ejection systolic murmur + 4th HS
- PO
What are the differentials for AS?
- Aortic sclerosis
- hypertrophic cardiomyopathy
What test will you order for AS?
- ECG
- LVH
- p-mitrale
- LAD
- LBBB
- complete AV block
- CXR
- LVH
- calcified aortic valve
- Echo
- Doppler echo
- Cardiac catheter
How would you mx AS?
- valve replacement
- TAVI (transcatheter aortic valve implantation) - if unfit for surgery
What is aortic sclerosis?
- senile degenration of the valve
What is the feature of aortic sclerosis?
- ejection systolic murmur but no carotid radiation
- normal pulse
What are the acute causes of aortic regurgitation?
- infective endocarditis
- ascending aortic disection
- chest trauma
What are the chronic causes of AR
- Marfan’s, Ehlers-danlos, osteogenesis imperfecta
- rheumatic fever
- Takayasu arteritis
- RA
- SLE
- appetite suppressants (fenfluramine, phentermine)
- seronegative arthritides
- HTN
What are the sx for AR?
- exertional dyspnoea
- orthopnea
- PND
- palpitations
- angina
- syncope
- CCF
What sound does AR produce?
- end diastolic soft murmur
- Austin Flint murmur - heard at apex, early diastolic rumbling murmur
What are the signs for AR?
- Collapsing water hammer pulse
- Wide pulse pressure
- displaced, hyperdynamic apex beat
- Corrigan’s pulse
What is Corrigan’s pulse?
- rapidly appearing and disappearing pulse at carotid
What test would you order for AR?
- ECG
- LVH
- CXR
- cardiomegaly
- dilated ascending aorta
- pulmonary oedema
- Echo
- Cardiac catheterization
How would you mx AR?
- ACEi - reduce systolic hypertension
- Echo every 6-12 months - monitor
- valve replacement
What are the cx of AS?
- HF
- Arrhythmia
- Stroke
- Death
What defect would give an ejection systolic that is louder on inspiration?
- pulmonary stenosis
- atrial septal defect
What heart sounds will be produced with bicuspid aortic valve?
- Without calcification
- Early systolic ejection click
- Blowing diastolic murmur
- With clacification
- ejection Systolic murmur
