Valve Disease Flashcards
Aortic Stenosis
- Most common Valvular Disease
- 1/4 pts with Valvular Disease
- 80 % Adults with no symptoms
- Blood is unable to flow freely from the left ventricl to the aorta during aortic stenosis
Aortic Stenosis
Etiology
- Congenital (bicuspid & unicuspid)
- Degenerative calcific
- Rheumatic fever
- Radiation
- Associating Risk Factors
LDL
Diabetes
Smoking
CKD
Metabolic syndrome
Aortic Stenosis
Pathophysiology
Stiffening/Narrowing of Aotic Valve creates dilation of L/A Dilation dicrease SV
Lead to
Left Ventricular Hypertrophy
Incoplete Emtying of left Atrium
Lead to
Decrease CO
Aortic Stenosis
sigh and symptoms
-
Cardinal symptoms
* Exertional dyspnea
Angina pectoris
Syncope - Mid-systolic murmur
-
Acute pulmonary edema
Peripheral cyanosis
* Cachexia - Easy fatigue
- Orthopnea & Paroxysmal dyspnea
- Narrow pulse pressure
- Slow rise in carotid arterial pulse
- Palpable S4 in left lateral recumbent
- Sudden death
Aortic Stenosis
Clinical Findings
-
ECG
Left ventricular hypertrophy
ST segment depression
T-wave inversion -
Chest x-ray
Dilated ascending aorta (frontal view)
Calcified aortic valve (lateral view) -
Echocardiogram
Thickening & calcification
Reduced systolic opening
LV hypertrophy
Doppler ID diastolic dysfunction -
Cardiac catheterization
Multivalvular disease
Asymptomatic noncalcific congenital AS
Obstruction of LV outflow elsewhere
Screening for CAD prior to surgery
Aortic Stenosis
Medical Management
* Lifestyle modification
No strenuous exercise or competitive sports
Avoid dehydration
* Medical Management
Beta blockers & ACEi
Nitrates
Statin
Evaluate q 1-2 years with echo
* Anticoagulation & Antiplatelet therapy
* Valvular atrial fibrillation
* Surgical valves
**
Aortic Stenosis
Antigoagulation and Antiplatelets
- Valvular atrial fibrillation & Mechanical valves
- Coumadin approved
- INR goal: 2.0-3.0
- Target INR: 2.5
- Older mechanical valves and/or additional factors
Target INR: 3.0 - Consider antiplatelet therapy
- Bioprosthetic
- Selective approach to anticoagulation
- Risk factors (i.e. A-fib)
- Coumadin x3-6 months + ASA
- No risk factors
- Initiate Aspirin
- Transcatheter Aortic Valve Replacement (TAVR)
6 months of Plavix + lifelong ASA therapy
Aortic Stenosis :
Surgical Managment
- Aortic Valve Replacement (AVR)
Severe AS w/ reduce LVEF
CABG with moderate/severe AS
Age is not an absolute contraindication
Tissue (>65 yo) vs Mechanical - Transcatheter Aortic Valve Replacement (TAVR)
High and intermediate surgical risk
Not available for congenital AS - Percutaneous Aortic Balloon Valvuloplasty (PABV)
- Congenital, noncalcic AS
Valvular Heart Disease
*** Rheumatic Fever **
* number one cause of Valvular Diseases in undeveloped counties due to overcroding popultion Can Start from (Strep A throat )
Semilunar Valve
- Pulmonary Valve( RT Ventricle to Pulmonary Vain )
- Aortic Valve ( Left Ventricle to Aorta )
Atroventricular Valve
- Mitral (Left A to V)
- Tricutspi (RT A to V )
**Stenosis: Narros > Thickness Or Fused **
- **Narros Valve Opening Due to
Valvee leaflets may become** fused or thickened **
Valve cannot open freely > obstucts the normal flow of blood
Valvular Stenosis
Cause & Effect
- The chamber behind the stenotic valve is subject to greater stress.
- More pressure is generated to force blood through the narrowed opening
- Heart compensates wiht gradula *hypertrophy and dilation of mycordium
- *Leading to HF *
Valvular Regurgitation
Physiology
- Incomplete Closure of teh Valve
- Scarring and regraction of valve leaflets or weakended support structure
- Backflow of blood into chamger
**Valbular Regurgitation
Cause and Effects
> Venteicular Dilation and Hypertrophy **
- Causes the heart to pump the same blood twice
- The heart dialtes to accommodate more blood
- Heart compensates with** ventricular dilation and hypertrophy **
- Heart Failure Ensues
