Cardio station Flashcards
Why check for anaemia in aortic stenosis
Heydes syndrome
AS + Angiodysplasia
[also anaemia of chonic disease esp if elderly
-Very rare haemolysis through native valve ]
When is AS murmur loudest
held expiration
over aortic area
Pulse in AS?
Slow rising / weak
Key thing to look for on exam if suspected AS?
Signs of cardiac decompensation
- Raised JVP
- Bibasal crackles
- Peripheral oedema
Key DDx of AS murmur
Systolic murmur
- Mitral regurg
- HOCM
- Aortic sclerosis
- VSD especially if young
- Pulmonary stenosis - very rare
Ix to confirm AS
ECG - ?LVH
Echo - confirm gradients
Bloods - Full blood count - anaemia / WCC
Inflam markers - CRP
Blood cultures ?IE
Chest xray ? overload
Difference between murmur between AS and aortic sclerosis
Usually shorter and softer
Aetiology of AS
80% degenerative calcific
congenital bicuspid valve
rare but possible - rheumatic fever
How to confirm severe aortic stenosis on exam / ix
Exam
Nature of murmur
slow rising pulse
evidence of cardiac decompensation
Ix
Echo
LVH on ECG / LBBB
[history of decompensation]
Why ECG pre TAVI
10% go on to have PPM
?Pre existing conduction disease
How to tell AS on echo
Peak gradient across valve >64
or mean gradient >40
[best measure is ratio of velocity over AV vs LVOT dimentional index]
When TAVI vs AVR
> 75 - likely TAVI
<75 - likely surgical - unless not fit
TAVI - more PPM, less bleeding risk
quicker recovery
less AF, Less CKD
Who is not suitable for a TAVI
Bad PVD
Malignant features of annulus
Bad CAD - would be too hard for stents
in <75 Who might the surgeons not want to operate on for AVR
Previous chest radiotherapy
Previous sternotomy
patient LIMA to LAD
Pulm HTN
Severe LVSD
Work up for a TAVI
Bloods - routine
Echo
ECG
If smoker - LFTs
Angio
TAVI CT
Consider carotid doppler
Key complications of TAVI
PPM - 10%
Vascular issues - Fem artery
Stroke / coronary blockage
Life expectancy AS with decompensation
50% at 1 year
Murmurs louder when?
Right-sided murmurs
- Louder during inspiration.
- inspiration increases blood flow to the vena cava, which increases venous return to the right side of the heart.
Left-sided murmurs
- louder during expiration.
- expiration increases blood flow to the left side of the heart by constricting pulmonary vessels.
What is / When do you get paradoxical splitting of s2?
How to make it more obvious?
Paradoxical splitting of S2
This occurs when the pulmonary valve (P2) is heard before the aortic valve (A2).
This is caused by conditions like severe aortic stenosis or left bundle branch block.
During inspiration, paradoxical splitting causes narrow splitting of S2, and during expiration, it causes wide splitting
