Sketchy Path: Aortic Stenosis and Aortic Regurgitation

Question 1

Aortic stenosis most commonly presents in the _____________ decades of life.

Answer 1

6th or 7th (like the older stepmother pinching the princess cap)

Question 2

Aortic stenosis in the elderly is caused by ______________.

Answer 2

dystrophic calcification (like the milk on the stepmother’s lip)

Question 3

What causes the calcification in aortic stenosis?

Answer 3

Endothelial cell death (like how the hat is turning dark where the stepmother has touched it)

Question 4

Although it was once thought that valve calcification was normal, it’s now known that ______________ increase the risk of it developing.

Answer 4

hypertension and atherosclerosis (like the hot candle that looks like the bursting red pipes of HTN)

Question 5

Those with _______________ develop aortic calcification much earlier.

Answer 5

bicuspid aortic valves (like the bicuspid horse’s mouth)

Question 6

Aortic stenosis can lead to what heart pathology?

Answer 6

Concentric hypertrophy (like the conch worn by the stepmother)

Question 7

How will the heart of someone with aortic stenosis change?

Answer 7

The left side will become larger (like the how the fairy godmother’s left wing is enlarged)

Question 8

Like with mitral stenosis, the left atrial enlargement in aortic stenosis can also ______________.

Answer 8

cause atrial fibrillation (like the irregularly irregular signal coming from the fairy’s wand)

Question 9

List some of the symptoms of aortic stenosis.

Answer 9

• Dyspnea on exertion (mouse exhausted)
• Fixed cardiac output (dim flashlight)
• Angina (angina anvil near the fireplace)
• Syncope (anvil SINKING into the ground)

Question 10

Those with aortic stenosis are extra sensitive to atrial disruptions (like fibrillation). Why?

Answer 10

The stiff left ventricle requires the “atrial kick” to fill with blood. Without it, the preload for the LV decreases and the LV cannot generate pressure to get past the stenotic aortic valve.

Question 11

The aortic stenosis murmur can radiate to ____________.

Answer 11

the carotids (like the two red pipes above the fireplace)

Question 12

What gallop can be heard in aortic stenosis?

Answer 12

S4 (like the stiff chair that Cinderella knocked over)

Question 13

The pulse in those with aortic stenosis will be _______________.

Answer 13

late and weak (like the sign saying “Tardus and Parvus”)

Question 14

What two sounds indicate that aortic stenosis is severe?

Answer 14

• Diminished S2 (like how the second picture of Cinderella is crossed out)
• Late peaking S2 (like how the ugly photos of Cinderella when she was young show that she peaked late)

Question 15

Maneuvers that ____________ increase the intensity of aortic stenosis murmurs.

Answer 15

increase preload (like squatting)

Likewise, maneuvers that decrease preload –like standing –will decrease the intensity of the murmur.

Question 16

What hematologic effect can aortic stenosis cause?

Answer 16

Schistocytes (like the sheared tomatoes)

Question 17

The most common cause of aortic regurgitation in the developing world is ________________.

Answer 17

acute rheumatic fever (like the ugly stepsister with the aortic cap regurgitating milk on herself next to the RHUbarb pie)

Question 18

The most common cause of aortic regurgitation in the U.S. is ________________.

Answer 18

calcified aortic valves that don’t close (like the gratuitous amount of milk spilled by the ugly stepsister)

Question 19

Other than calcified valves, what else can cause aortic regurgitation?

Answer 19

• Tertiary syphilis (like the tree-bark aorta plant)
• Takayasu and giant cell arteritis (like the dilated, inflamed base of the tree)
• Ankylosing spondylitis (like the bamboo next to the tree)
• Marfans (Martian)
• Ehlers-Danlos
• Osteogenesis imperfecta
• Infective endocarditis (like the heart lantern)

Question 20

Long-term, aortic regurgitation can cause ______________.

Answer 20

eccentric hypertrophy (like the sashes in series on the stepsister’s dress)

Question 21

What vital sign is suggestive of aortic regurgitation?

Answer 21

Widened pulse pressure (like the widened water bed from the little stepsister jumping on it)

Question 22

What does the increased pulse pressure lead to on physical exam?

Answer 22

• Head bob (doll’s head shaking up and down in the little stepsister’s arms)
• “Water hammer” pulses (water bed)
• Pulsations in fingernail beds (like the fingernail pillow)

Question 23

What murmur is suggestive of aortic regurgitation?

Answer 23

Early-diastolic descrescendo murmur (like the diastolic diamonds on the ugly stepsister)

It’s an early diastolic murmur because blood immediately is pulled back across the valve.

Question 24

Aortic regurgitation can lead to what gallop?

Answer 24

S3 (like the slushie on the water bed)