Cardio Block 2 Flashcards
What is the most important and weakest part of the visit when assessing heart valves?
PE- weakest
Hx/Diagnostic study- strongest
What are the common causes of aortic valve diseases?
Congenital bi/unicuspid- most common congenital heart Dz, seen in PTs <70y/o
Degenerative Ca+- wear/tear from atherosclerosis/CAD, seen in PTs +65/yo
Worldwide- RF, usually mitral valve involvement then aortic valve
How much of an AS occlusion is needed for Sxs?
What is the bodies remodeling response to AS/inc AL and what other issue can be forced to develop?
90% for Sxs to appear
Concentric hypertrophy, can lead to MR
What is the sequence of pathophysiologic changes seen in AS?
AS, Outflow obstruction, Inc EDP, Concentric* LVH, LVF, CHF, Subendocardial ischemia
Why does exertion syncope occur with AS during exercise?
Why does CHF occur?
LV can’t increase CO, dilation causes decreased cerebral perfusion pressure
Inc AL causes contractile dysfunction and inc LV diastolic volume/press, pressure backs into pulmonary vessels, inc alveoli congestion
What are the S/Sxs of AS
How are AS seen on PE?
Prolonged ASx period:
Exertion induced dyspnea, angina, dizziness
Harsh Cresc/Decresc at RUSB w/ bell/diaphragm, radiates to carotid
Narrow pulse pressure
Displaces PMI
Define Pulsus Parvus et Tardus
How does AS cause angina?
Weak and late/slow rising best appreciated at carotid/PMI and carotid at same time
Imbalance between supply/demand
Inc LVDP reduces coronary perfusion pressure gradient
How does AS present on ECG?
What Sx is seen in PTs w/ severe form?
LVH, LAE, possible A-Fib
A-Fib leading to HF/Stroke
Where is A-Fib seen on an EKG?
How does AS appear on CXR?
Bi-phasic in V1 or Lead 2
LVH, Calcified leaflets, CHF if advanced
How does Echo appear on Echo?
Bicuspid aortic valves are associated w/ increased risks for ?
TTE shows inc wall thickness and determines severity
Aneurysm and Dissections
If AS can’t be seen w/ Echo, what test is ordered?
Who else receives this test?
CT or MRI
Candidates for Transcatheter Aortic Valve Replacement (TAVR)
When do AS PTs get an Exercise Test?
How are AS PTs treated?
Asx severe AS to confirm absence of Sxs
Limit activity
No optimal pharm Tx
Caution w/ anti-hypertensive meds
NO diuretics
How often do AS PTs receive Echos?
At Dx Mild= Q3-5yrs Mod= Q1-2yrs Sev= Q6-12mon Any time Sxs change
What is the only true effective Tx for PTs w/ severe AS?
What is the alternate procedure for kids and young adults w/ congenital AS?
Valve replacement- preferred method is transcatheter aortic valve replacement
Balloon aortic valvuloplasty
What type of PT gets a mechanical valve and what prophylaxis do they get?
Who gets a bioprosthetic valves?
Younger PTs, Coumadin
PTs that won’t live more than 10yrs, no coumadin
What is the prognosis of AS?
What AS PTs do we screen for unnoticed Sxs?
ASx- near normal survival Angina= <5yrs Syncope= <3yrs Dyspnea= <2yrs A-Fib precipitates overt HF and increases mortality rates
ASx PTs
What is the normal cross sectional area of the aortic valve?
What is the most common etiology of AI in developed countries?
3-4cm^2
Congential bicuspid
Dilation of aortic root- Marfans/Ehlers-Danlos
Acute AI is a medical emergency if it appears in ? situations?
Native valve Endocarditis Aortic dissection Traumatic rupture of leaflets Iatrogenic- failed valvotomy/valve repair
What is the sequence of pathophysiology events that occur in AI?
Acute AR is usually associated with rapid decompensation due to ?
AR, Vol overload, LV dilation, Wide Pulse Pressure, Inc wall tension, Pressure overlaod, LVH
Inability to accomodate inc end DBP
How is Chronic AR different than Acute?
How does this compensation cause a widened pulse pressure and what is unique about this change?
Dilation w/ less hypertrophy
Drop in aortic diastolic pressure
High LVSV, reduced DBP= Wide pulse pressure, HALLMARK of AR**
How does acute AI present?
How does chronic AI present?
Acute Pulmonary Edema
Wide pulse pressure, CHF Sxs, Angina, Atypical chest pain
What are 5 Signs associated w/ AI and what are they all indicative of an increased risk for?
De Musset- head bobbing w/ systole Corrigans- water hammer Quincke- nail bed pulsations Traube- pistol shot heard over radial/femoral Duroziez- to and fro heard over femoral
Inc stroke volume and widened pulse pressure
What type of murmur is AI?
AI valve etiology is best hear at ? while root etiology is best hear at ?
High pitched, blowing diastolic murmur at Erb’s point w/ PT leaning fwd and exhaling
Valve= LSB 2/4ICS Root= RSB and apex
Define Austin Flint murmur
Low rumble during mid systolic sound from normal diastolic flow from LA hitting anterior leaflet of MV, which is partially closed due to inc force of AR
AR + physiological MS w/out opening snap