The Basics Flashcards
What are the three primary causes of AS (from most to least common)?
- Calcific (most common)
- Rheumatic
- Congenital (least common)
What are the types of bicuspid aortic valve?
Type 0: 0 raphe, true BAV
Type 1: 1 raphe (most commonly raphe between RCC and LCC)
Type 2: 2 raphe (functionally unicuspid)
What is a raphe?
Seam/fibrous ridge between two cusps (also known as a false commissure)
Which is the most common type of BAV?
Type 1 (one raphe) with raphe between the right and left coronary cusps
Prevalence of AS in patients < 50 years old?
AS patients < 50 years old are likely to have a bicuspid AV
Prevalence of AS in patients > 70 years old?
AS patients > 70 years old are likely to have a tricuspid AV
Progression: How does AV sclerosis become calcific AS?
Three stages:
- Endothelial Damage
- Fibrosis
- Calcification
Initiating factors of AS
- Mechanical stress
- Bicuspid aortic valve
- Genetic factors
Risk factors for AS
- Older age
- Male
- Hypertension
- Diabetes
- Smoking
- Metabolic syndrome
Haemodynamic Consequences of AS
- Adaptation of the left ventricle
- Left atrium
- Cardiac output
- Perfusion
- End-stage
Haemodynamic Consequences of AS: Adaptation of the Left Ventricle
- Increased LV systolic pressure leading to concentric hypertrophy
- Decreased LV compliance
- Increased filling pressures
Haemodynamic Consequences of AS: Left Atrium
- LA dilatation (as a result of decreased LV compliance and increased LV filling pressures)
- Increase in LAP
- Can lead to development of AF
Haemodynamic Consequences of AS: Cardiac Output
- Initially normal CO (due to compensatory mechanisms)
2. CO declines as disease progresses
Haemodynamic Consequences of AS: Perfusion
Decreased CO leads to decrease in 1) myocardial and 2) cerebral perfusion
Haemodynamic Consequences of AS: End-Stage
- Reduction in LV contractile function
- Pulmonary hypertension
- RV dysfunction
