Aortic Valve disorders Flashcards

1
Q

What is aortic stenosis?

A

Narrowing of the aortic valve

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2
Q

What are possible causes for aortic stenosis?

A
  1. Aortic sklerosis
    1. calcification and fibrosis of the aortic valve
    2. common, increases with age
  2. Bicuspid aortic valve
    1. most common congenital reason for aortic stenosis
    2. patients present generally younger than P. with aortic sklerosis
  3. Rheumatic fever
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3
Q

Explain the associated pathophysiological process associated with aortic stenosis

A

Narrowing of Aortic valve during systole –> higher left- ventricular pressure during systole –> Leading to Left ventricular hpertrophy–>

  • Reduced filling in diastole –> Left heart failure
  • increased myocardial oxygen demand
  • Decreased coronary flow reserve (coronary blood supply)
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4
Q

When do signs and symptoms in a patient with Aortic stenosis normally present?

A

Normally asymptomatic for long time, present in severe stage of disease

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5
Q

What are presenting symptims of Aortic stenosis

A

SAD

  • Syncope?/ Dizziness
  • Angina Pectoris
    • often but not necessaryly worse on exertion
  • Dispnoea
  • Wheezing (if led to global hear failure with right atrial hypertrophy and compression of trachea)
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6
Q

What are signs of Aortic stenosis on examination?

A
  • Systolic murmor
    • can also be heared in carotids
  • Decreased pulse pressure –> small blood pressure amplitude
  • Weak and delayed distal pulse
  • Palpable systolic thrill
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7
Q

What is the epidemiology or Aortic stenosis?

A

Most common heart disease

  • high prevalence in over 75 (up to 12%)
  • increases with age
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8
Q

Which investigations would you do in someone with suspected Aortic stenosis?

A

Bloods

  • pro - BNP
  • ggf. Trop

Echocardiogram (TTE)

  • assessment for valve and looking for aortic valve calcification
  • (increased trans valvular pressure gradient and signs of cardiac remodelling)

ECG

Chest X-Ray

  • signs of pulmonary oedema and left ventricular hypertrophy
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9
Q

What are possible complications in a patient with Aortic stenosis?

A

Acute decompensated Heart Failure

Atrial Fibrillation

Cardiogenic shock

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10
Q

What is the treatment for Aortic Stenosis?

A

Only definitive treatement: surgical valve replacement

Otherwise: treat risk factors

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11
Q

What is the prognosis for patients with aortic stenosis?

A

If asymptomatic:

  • Mortiality <1% in next year
  • If symptomatic Mortiality >50% if left untreated
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12
Q

What are risk factors for developing Aortic stenosis?

A
  • Age >60
  • Bicuspid aortic valve
  • Rheumatic heart disease
  • Chronic kidney disease
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13
Q

What is aortic regurgitation?

A

Aortic insufficiency –> aortic valve does not fully close in diastole and blood goes back into ventricle

  • might be acute or chornic
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14
Q

What are possible reasons for acute aortic regurgitation?

A

bacterial endocarditis or aortic dissection

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15
Q

What are the most common reasons for chronic aortic regurgitation?

A
  1. Congenital bicuspid valve:
    1. young adults developed countries
  2. Rheumatic heart disease:
    1. developing countries
  3. Distortion or dilation of the ascending aorta and aortic root
    1. Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome)
    2. Tertiary syphilis
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16
Q

What is the effect of aortic regurgitation on BP?

Why?

A
  • Increases systolic BP (more blood to be pumped out
  • Decreases diastolic BP (blood back into LV)
    • Wide pulse pressure + Waterhammer pulse
17
Q

What happens in acute aortic regurgiation?

A
  • end-diastolic pressure in LV is increased
    • Back to lungs –> increased pulmonary pressure with pulmonary oedema
  • Decreased cardiac output if severe → cardiogenic shock and myocardial ischemia
18
Q

What happens in chronic aortic regurgitation?

A
  1. Compensatory increase in stroke volume
    1. Compensated HF –>
    2. LV- eccentric hypertrophy
    3. leading to LV systolic dysfuncion
      1. Decompensated HF
19
Q

What are presenting symptoms of Aortic regurgitation?

A

Acute

  • Sudden, severe dyspnea
  • Symptoms related to underlying disease (e.g., fever due to endocarditis, chest pain due to aortic dissection)

Chronic AR

  • May be asymptomatic for up to decades despite progressive LV dilation
    • Palpitations
    • Symptoms of left heart failure
    • Exertional dyspnea
    • Angina
    • Orthopnea
    • Easy fatigability
  • Syncope
  • Symptoms of high pulse pressure (e.g., head pounding, rhythmic nodding, or bobbing of the head in synchrony with heartbeats- de Musset sign)
20
Q

What are signs on examination in a patient with aortic regurgitation?

A
  • Auscultation
    • Early diastolic murmor (High-pitched, blowing, decrescendo)
    • S3
    • Worsens with squatting and handgrip (due to increased afterload)
      • severe stages migh mid-systolic murmor
  • Increased PP
    • Waterhammer pulse
    • Quinkes sign (visible capillary pulse)
    • Visible pulsation in head/caroids
21
Q

What are risk factors for developing aortic regurgiation?

A
  • Congenital bicuspid valve
  • Connective tissue disorders
    • Marfans/ Ehlers-Dahlos syndrome
  • Bacterial Endocarditis
  • Rheumatic Fever
  • Aortitis
22
Q

What is the epidemiology of aortic regurgitation?

A
  • less common than Aortic stenosis and mitral regurgitation
  • increases with age, more likely in men than women
23
Q

Which investigations would you order in a patient with suspected aortic regurgitation?

A
  • CXR
    • Cardiomegaly + aortic dilation
  • ECG
    • LV hypertrophy
  • Echo
    • visualisation of aortic valve
  • Doppler
    *