Diagnostic Imaging, Aortic Stenosis, Aortic Insufficiency

Question 1

What are the causes of aortic stenosis?

Answer 1

Congenital (bicuspid, unicuspid, quadricuspid)
Acquired (degenerative calicific, rheumatic fever, obstructive vegetations, radiation, rheumatoid conditions)
Non-valvular (coarctation of the aorta, sub-valvular/HOCM)

Question 2

Grading Scale of Aortic Stenosis-
Mild?

Answer 2

Mean gradient of <25mmHg
AVA >1.5cm^2

Question 3

Grading Scale of Aortic Stenosis
Moderate?

Answer 3

Mean gradient of 25-40mmHg
AVA of 1.0-1.5cm^2

Question 4

Grading Scale for Aortic Stenosis
Severe?

Answer 4

Mean gradient of 40-70mmHg
AVA 0.6-1.0cm^2

Question 5

Clinical Signs of Aortic Stenosis?

Answer 5

Dyspnea
Syncopy
Angina

Question 6

What murmur is associated with AS?

Answer 6

Crescendo-decrescendo
systolic ejection murmur

Question 7

Anatomy of the Aortic Valve

Answer 7

Between the left ventricle and the aorta
Three leaflets
Systole/open; diastole/closed

Question 8

Definition of Aortic Stenosis

Answer 8

Diseased aortic valve decreases the left ventricle’s ability to eject blood into the aorta
Results in a pressure gradient between LV and AO

Question 9

Normal aortic valve size?

Answer 9

2.5 to 3.5 cm^2

Question 10

Current treatments for AS?

Answer 10

Balloon aortic valvuloplasty
Transcatheter Aortic Valve Replacement
Surgical Aortic Valve Replacement

Question 11

What cause of aortic stenosis is most commonly associated with younger adult populations?

Answer 11

Congenital (typically bicuspid aortic valve)

Question 12

The hemodynamic finding for aortic stenosis?

Answer 12

Systolic pressure gradient

Question 13

Patients usually become symptomatic around what AVA?

Answer 13

0.8-1.0cm^2

Question 14

What is parvus tardus?

Answer 14

Weak and delayed upstroke due to left ventricular outflow tract obstruction. Physical exam finding in AS.

Question 15

Two types of aortic insufficieny?

Answer 15

Acute and Chronic

Question 16

Acute aortic insufficiency causes?

Answer 16

Endocarditis (bacterial)
Trauma (like aortic dissection)
Post-surgical iatrogenic (improper placement of TAVR, post BAV, dehiscence of sewing ring)

Question 17

Chronic aortic insufficiency causes?

Answer 17

Congenital (connective tissue disorders, autoimmune disorders, bicuspid or unicuspid valve)
Acquired (syphilis, ankylosing spondylitis, rheumatic disease, aortic stenosis)

Question 18

Physiological changes in acute AI?

Answer 18

Increased LV EDP due to volume overload occurring rapidly
Cardiac output reduced
Emergent treatment needed, can cause sudden death

Question 19

Symptoms of acute AI?

Answer 19

Weakness
Severe dyspnea/cyanosis
Hypotension
Tachycardia
Angina
Cool/clammy skin

Question 20

Treatment for acute AI?

Answer 20

Morphine (to reduce myocardial oxygen demand)
Diuretics (eg Lasix. To remove fluid volume)
Antibioltics for bacterial endocarditis
Valve replacement (definitive treatment)

Question 21

Physiology of chronic AI?

Answer 21

Chronic LV volume overload
LV compensates, pressure changes cause LA chamber dilation, pulmonary circuit and right heart increased pressure

Question 22

Symptoms of chronic AI?

Answer 22

Fatigue
Nocturnal dyspnea
Orthopnea
Abdominal discomfort
Awareness of heart beat

Question 23

Murmurs associated with AI?

Answer 23

Diastolic high pitched decrescendo murmur best heard at left upper sternal border

Austin Flint murmur: regurgitated blood from AI hits mitral valve causing apical murmur. Diastolic rumble.