Valves

Question 1

Acute aortic valve incompetence:
- Causes
- Clinical
- Management

Answer 1

Causes
- IE, trauma, RHD, dissection, bicuspid

Clinical
- Diastolic murmur (incl. AustinFlint)
- APO
- Profound cardiogenic shock
- Angina
- Head-bobbing
- Collapsing/ Waterhammer pulse
- Wide pulse pressure

Management
- Inodilation
- Surgery
- IABP is contraindicated

Question 2

Acute MITRAL valve incompetence:
- Causes
- Clinical
- Management

Answer 2

Causes
- IE, trauma, RHD, chordae or papillary rupture

Clinical
- APO
- Cardiogenic shock
- Early systolic murmur
- Diastolic ‘rumble’

Management
- PPV
- Inodilation
- AVOID PRESSORS
- Surgery

Question 3

Main issues in aortic stenosis:

Answer 3

LVH and outflow obstruction

–> Preload dependent
–> Susceptible to afterload
–> Unable to increase cardiac output
–> Prone to ischaemia
–> Prone to arrythmia

Exertion (or other) can rapidly cause pump failure.

Question 4

Decompensation in critical AORTIC STENOSIS:
- Triggers
- Clinical
- Management

Answer 4

Triggers
Exertion, AF, preload reduction

Clinical
- Exertional collapse
- APO
- Cardiogenic shock
- Ischaemia of hypertrophied LV
- Split 2nd heart sound
- Systolic murmur

Management
- Support preload
–> Fluid
–> Avoid PPV
- Inodilation
–> eg. dobutamine
- Surgery

Question 5

Echo values that define ‘severe’ AS:

Answer 5

Vmax <4
AVA <1
Gradient >40