Valvular disease (2) - Sheridan Flashcards by Chris Rodarte

Demusset’s sign

Bobbing of head with cardiac cycle (Aortic regurgitation)

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AS CXR

Calcification of aortic valve/aorta

LVH

Post-stenotic aortic enlargement

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EKG Aortic regurgitation

LVH

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Mitral regurg increases __________ pressure

PCWP

Pulmonary vein

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Medical therapy for AS

Control HTN
Control Arrhythmias
Cautious use of diuretics

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Occasionally can _________ the valve/commissures in Aortic regurgitation

repair/resuspend

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Aortic regurgitation may result in _____ in the face of normal coronary artieries

angina

(microinfarcts?)

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Watsons sign

Bounding Limb pulse (Aortic regurgitation)

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Medical therapy for Aortic regurgitation

Afterload reduction

diuretics

treat HTN

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Classic AS symptoms

angina

syncope

CHF (exertional dyspnea)

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Normal history for AS

Asymptomatic for years

Clinical symptoms happens when course is malignant

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Aortic regurgitation leads to what morphological changes

LV dilatataion

Eccentric Hypertrophy (opposed to concentric AS hypertrophy with increased wall thickness, but no change in chamber size - until fails long-term)

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In MR, the ____ dilates ______

Annulus dilates posteriorly

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Mitral regurg patients have increased susceptibility to

Bacterial endocarditis

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Pathological effects of Aortic regurgitation

Subendocardial ischemia from decreased diastolic blood flow

Increased diastolic ventricular pressure, LVH, work load

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Aortic regurgitation observation

serial echos

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What is preserved in mitral regurg surgery

posterior leaflet chords are preserved

to preserve LV geometry and function

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Surgical inidications for AS (asymptomatic with severe)

EF less than 50%
Undergoing cardiac surgery for another reason

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Aortic regurgitation vitals changes/ Auscultation

Wide pulse pressure

Diastolic blowing murmur

Austin Flint murmur (when regurgitant jet hits anterior leaflet of mitral valve it tends to close it and causes murmur at apex)

Water hammer pulse = bounding periph pulse

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If AS patient is acceptable surgical risk, the surgery should be _______

AV replacement

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Mitral regurg observation

Serial Echos to look for LV decompensation

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Duroziez’s sign

Systolic/Diastolic murmur over the femoral arteries

(Aortic regurgitation)

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Morphological changes in AS

May lead to…

Concentric LV hypertrophy (with increased 0xygen demand, decreased subendocardial flow in diastole)
Microinfarcts with resulting myocardial scarring

May lead to chronic LV failure

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Aortic regurgitation may result in massive…

dilatation of LV = Cor Bovinum

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Valve surgery - types of replaements

**Bioprosthetic** (pericardial or porcine), no anticoag needed, valve can deteriorate (10-20 year lifespan) **Mechanical** - Titanium, anticoag's required, life-long

Severe AVA =

less than 0.8

Acute mitral regurg is caused by... Result?

Ruptured papillary muscle (post MI) normal/small atrium cant accomodate = pulmonary edema and possible in extremis status

Average survival after onset of AS symptoms

CHF - 2 years Syncope - 3 years Angina - 5 years

\_\_\_\_\_\_ is increased in M regurg

LA size ccan accomodate extra load if gradual

Corrigan's sign

bounding carotid pulse (Aortic regurgitation)

AS typical ECG

LVH IVC delays like right or left BBB, AV-nodal block, or Afib

AV replacement for...

1. Severe regurg with symptoms 2. Severe regurg with no Sx, but *or severe LV dilatation (LVESD \>50%)* 3. Moderate Aortic regurgitation with another concommittent surgery

Surgical indications for AS (symptomatic with severe)

Symptomatic patients wtih severe AS * 0.8 AVA * mean gradient more than 40mmHg * Aortic velocity more than 4 m/sec

Dx of AS

Cath (assess coronaries, measure gradients, look for AI) CTA chest with 3D reconstruction

Pulse effects of Aortic regurgitation

Lateral displacement of LV apical pulse Widened PP

depending on the etiology of the Aortic regurgitation, may need to \_\_\_\_\_

replace the ascending aorta

Treatment for symptomatic mitral regurg

valve repair/ annuloplasty (this is also preferred for asymptomatic with severe regurg, LVESD at or above 40mm and ej. faction less than 60)

Most untreated AS patients die from

CHF

Most common for congenital AS

Bicuspid

Therapies for Mitral regurg

* diuresis * afterload reduction * rhythm control Possible anticoag and beta blockers

Auscultation - AS Carotid pulse?

Systsolic ejection murmur in right 2nd ICS (radiates to carotids Carotid pulse as a dimished upstroke

What is performed when surgical risk is too high

TAVR Trascatheter Aortic valve replacement \*For high risk when life expectancy is greater than 1 year

AR results in increased....

LVEDP LV diastolic volume Wall stress

AS Echo (what we're looking for)

Measure AVA Look for associated lesions EF Wall motion Chamber size Leaflet motion aorta size

Aortic regurgitation Echo, assessing:

regurgitant jet EF chamber sizes \*\*helps define etiology

20% of AS result in

ventricular arrhythmias (sudden death) \*the most fatal valve lesion

Most common AS cause

Degenerataive/calcific

Aotic stenosis types (causes)

Degenerative/calcific (senile calcific) Congenital Rheumatic

CXR - Aortic regurgitation

LV enlargement AA enlargement Pulm. edema increased LA

Mitral regurg results in _______ (Sx)

Fatigue Dyspnea Reduced exercise tolerance Palpitations/Afib

Aortic regurgitation surgery is usually \_\_\_\_

Aortic valve replacement

Quincke's pulse

Pulsating nail beds (Aortic regurgitation)

Mitral regurg causes

Too many to list. review.

AS may affect the conduction system if

Ca extends to conduction system

LV function in MR?

Usualy remains adequate for a while (even if severe MR) Eventually decompensates with LV dilation and decreased ej. fraction

CXR for mitral regurg

Enlarged LA (and eventually LV) Various degrees of pulmonary congestion

Aortic regurg causes

Too many. Review.

Mitral valve replacement is indicated if..

repair is not possible

AS pathology - cardiac cycle

Increased afterload Secondary impaired LV emptying during systole

Traube's sign

Pistol shot sound over large arteries | (Aortic regurgitation)

Sx for Aortic regurgitation

Dyspnea, othopnea, PND, angina, syncope (rare) May be asymp. for yearss with moderate-severe AR (when sx appear they herald LV dysfunction with frank CHF coming several yeaaras later)