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Cardio Week 5 > Clinical: Aortic Valve Disease > Flashcards

Clinical: Aortic Valve Disease Flashcards

1
Q

What are the most common prosthetic heart valves used in aortic valve replacement?

A
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2
Q
  • What makes the classic triad of aortic stenosis symptoms?
    • What are the associated patient percentages and life expectancies?
A
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3
Q

AORTIC REGURGITATION: SYMPTOMS

  • In Chronic Aortic Regurgitation
    • What happens to the left ventricle?
    • What happens to the right side of the heart?
      • What does this manifest as?
    • What long-term outcomes does this have on a PT?
A
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4
Q

What type of CHF is associated with Paroxysmal nocturnal dyspnea?

What type of CHF is associated with right-sided heart failure (edema)?

A

Both systolic CHF and Diastolic CHF may result in PND, RHF (edema)

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5
Q
  • When grading the severity of Aortic Stenosis via an echocardiogram, what two factors are you most concerned with?
    • What is the relationship between these two factors
A
  • When peak velocity increases, AVA (area of the vessel) gets smaller.
  • Faster peak velocity = worse grade
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6
Q

What is the ross procedure?

A
  • The Ross procedure (or pulmonary autograft) is a cardiac surgery operation where a diseased aortic valve is replaced with the person’s own pulmonary valve.
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7
Q

What is an Austin-Flint murmur?

A
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8
Q

AORTIC REGURGITATION: PE FINDINGS

  • What kind of pules are common?
  • What happens to the PMI?
  • What kind of murmur is heard, and where?
A
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9
Q

What is the De Musset Sign?

A

Bobbing of the head with each heartbeat (like a bird walking)

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10
Q

AORTIC REGURGITATION: SYMPTOMS

  • In Acute Aortic Regurgitation, what can happen to the left side of the heart?
    • What conditions does this manifest as?
A
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11
Q

AORTIC REGURGITATION: PE FINDINGS

  • What heart sounds are heard, besides the soft, high pitched, early diastolic decrescendo murmur at Erb’s point?
    • What are the causes of these sounds?
A
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12
Q
  • What Tx do you always avoid when providing medical therapy for aortic stenosis?
  • A patient has an inoperable case of aortic stenosis
    • What Tx do you use for heart rate control?
    • What Tx do you use for blood volume control?
  • What is the goal of medical therapy in aortic stenosis?
A
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13
Q

How do you know the answer?

What causes the Murmor?

What does the systolic ejection fraction indicate?

What treatment should be done?

A
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14
Q

What type of aortic stenosis is described here?

A

Aortic Stenosis due to Unicuspid/Bicuspid Valve

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15
Q

What is the only way to actually improve aortic stenosis?

A

surgery

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16
Q

What valve is this?

A
17
Q

Aortic Regurgitation

  • When do you find Aortic regurge as an isolated lesion?
  • What structures are abnormal in Aortic Regurgitation?
  • What are the main causes of Aortic Regurgitation? (5)
A
18
Q

Compare patient outcomes from having a TAVR for 24 months and 5-year post operation

A

TAVR is better than standard therapy for 24 months then is the same for 5 year outcomes

19
Q

Rank the following operations in order if unadjusted operative mortality (least or greatest)

  • Isolated AVR
  • AVR + CABG
  • AVR + MVR
A
20
Q

Why does syncope occur that is related to aortic stenosis?

A
  • Syncope = due to physical activity.
    • During exercise, blood is shunted to the working muscles.
    • In AS, CO is unable to increase enough to accommodate this decreased TPR.
    • Hypotension occurs and the cerebral perfusion is compromised leading to syncope.
21
Q

What patient population is associated with percutaneous Aortic Balloon Valvuloplasty (PABV) and what is this operation generally used for?

A
22
Q

What valve is this?

A
23
Q

What is the law of LAPLACE?

A
  • The larger the vessel radius, the larger the wall tension required to withstand a given internal fluid pressure.
    • For a given vessel radius and internal pressure, a spherical vessel will have half the wall tension of a cylindrical vessel.
24
Q

AORTIC VALVE: PATHOBIOLOGY

  • Where does blood flow in aortic regurgitation?
  • What happens to the left ventricle?
    • Why?
  • What can acute aortic regurgitation result in? (3)
A
25
Q

When is the best time to have a surgical intervention on a patient who has aortic stenosis?

A
  • Best time is when AVA is less than 1.0 cm^2 but BEFORE the left ventricle has failed
26
Q

All of these are can be associated with aortic regurgitation? What is a common feature that they all have?

A

All are associated with increased afterload

27
Q
  • When measuring aortic regurgitation Severity using Echocardiography,
    • What is jet size ratio?
      • Does it get bigger or smaller when aortic regurgitation gets more severe?
    • What is regurgitation fraction?
      • Does it get bigger or smaller when aortic regurgitation gets more severe?
A
28
Q
  • List the Aortic Root abnormalities that are associated with Aortic Regurgitation
    • What conditions can cause each of the abnormalities?
A
29
Q

AORTIC STENOSIS: PE FINDINGS

  1. What is Pulsus parvus et tardus?
  2. Describe the murmor assoicated with Aortic Stenosis (4)
    • Where is this best heard at?
  3. What happens to S2?
  4. What other conditions may be found with aortic stenosis?
A
30
Q

What type of operation is routinely used as part of a Transcatheter Aortic Valve Replacement (TAVR)?

A

Percutaneous Aortic Balloon Valvuloplasty (PABV)

31
Q

What prosthetic heart valves are used in TAVR?

A
32
Q

Compare Mechanical Vs. Bioprosthesis

Which is better and why?

A

Mechanical: Better survival rates due to less coagulation

33
Q

Where is Erbs point?

A

3rd intercostal space on the left

34
Q

What valve is this?

A
35
Q

What type aortic valve replacement is used in elderly patients with severe, calcific AS who are considered inoperable?

A

Transcatheter Aortic Valve Replacement (TAVR)

36
Q
  • In Tricuspid aortic valves that have aortic stenosis,
    • What does the stenosis usually arise from?
    • What are the common risk factors from stenosis?
    • What age group does this effect?
    • What is the most common type of stenosis?
    • How common is this due to Rheumatic Fever?
A
37
Q

What part of the mitral valve can be affected in aortic regurge if it is severe enough?

A

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