Aortic Valve disorders Flashcards
What is aortic stenosis?
Narrowing of the aortic valve
What are possible causes for aortic stenosis?
- Aortic sklerosis
- calcification and fibrosis of the aortic valve
- common, increases with age
- Bicuspid aortic valve
- most common congenital reason for aortic stenosis
- patients present generally younger than P. with aortic sklerosis
- Rheumatic fever
Explain the associated pathophysiological process associated with aortic stenosis
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)
When do signs and symptoms in a patient with Aortic stenosis normally present?
Normally asymptomatic for long time, present in severe stage of disease
What are presenting symptims of Aortic stenosis
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)
What are signs of Aortic stenosis on examination?
- Systolic murmor
- can also be heared in carotids
- Decreased pulse pressure –> small blood pressure amplitude
- Weak and delayed distal pulse
- Palpable systolic thrill
What is the epidemiology or Aortic stenosis?
Most common heart disease
- high prevalence in over 75 (up to 12%)
- increases with age
Which investigations would you do in someone with suspected Aortic stenosis?
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
What are possible complications in a patient with Aortic stenosis?
Acute decompensated Heart Failure
Atrial Fibrillation
Cardiogenic shock
What is the treatment for Aortic Stenosis?
Only definitive treatement: surgical valve replacement
Otherwise: treat risk factors
What is the prognosis for patients with aortic stenosis?
If asymptomatic:
- Mortiality <1% in next year
- If symptomatic Mortiality >50% if left untreated
What are risk factors for developing Aortic stenosis?
- Age >60
- Bicuspid aortic valve
- Rheumatic heart disease
- Chronic kidney disease
What is aortic regurgitation?
Aortic insufficiency –> aortic valve does not fully close in diastole and blood goes back into ventricle
- might be acute or chornic
What are possible reasons for acute aortic regurgitation?
bacterial endocarditis or aortic dissection
What are the most common reasons for chronic aortic regurgitation?
-
Congenital bicuspid valve:
- young adults developed countries
-
Rheumatic heart disease:
- developing countries
- Distortion or dilation of the ascending aorta and aortic root
- Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome)
- Tertiary syphilis
What is the effect of aortic regurgitation on BP?
Why?
- Increases systolic BP (more blood to be pumped out
- Decreases diastolic BP (blood back into LV)
- Wide pulse pressure + Waterhammer pulse
What happens in acute aortic regurgiation?
- 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
What happens in chronic aortic regurgitation?
- Compensatory increase in stroke volume
- Compensated HF –>
- LV- eccentric hypertrophy
- leading to LV systolic dysfuncion
- Decompensated HF
What are presenting symptoms of Aortic regurgitation?
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)
What are signs on examination in a patient with aortic regurgitation?
- 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
What are risk factors for developing aortic regurgiation?
- Congenital bicuspid valve
- Connective tissue disorders
- Marfans/ Ehlers-Dahlos syndrome
- Bacterial Endocarditis
- Rheumatic Fever
- Aortitis
What is the epidemiology of aortic regurgitation?
- less common than Aortic stenosis and mitral regurgitation
- increases with age, more likely in men than women
Which investigations would you order in a patient with suspected aortic regurgitation?
- CXR
- Cardiomegaly + aortic dilation
- ECG
- LV hypertrophy
- Echo
- visualisation of aortic valve
- Doppler
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