Valvular Heart Disease Flashcards
Most common cause of aortic stenosis
Degenerative/senile/sclerocalcific AS
Moat common congenital heart valve defect with male predominance
Bicuspid aortic valve disease
Severe LV obstruction is defined as
Mean systolic pressure gradient >40mmhg with normal CO
effective aortic orifice area < 1cm2 or < 0.6cm2/m2 BSA
In the early course of severe AS - indicates reduced compliance of the hypertrophied LV
Elevated LV EDP + preserved EF
In late AS deterioration of contractile function is due to
Excess afterload: dec CO and LV- aortic pressure gradient, inc in the mean LA, PA, and RV pressure
Increased oxygen demand due to hypertophied LV in AS causes
Angina
Cardinal symptoms in AS
Angina, syncope, dyspnea (AS-D)
Symptoms of LV failure
Orthopnea, PND, pulmo edema
Slow rise of peripheral arterial pulse to a delayed sustained peak in AS
Pulsus parvus et tardus
Synchronous or paradoxically split s2 in AS
Delayed closure of aortic valve as the LV systole becomes prolonged
Murmur in AS
Midsystolic ejection murmur loudest at the base of the heart most commonly in 2nd right ics
AS Severity in 2D echo
Severe:< Icm
moderate:1-1-5cm2
M i I d:1.5-2 cm2
In Aortic Stenosis average time Of death after onset Of Symptoms( in the absence of surgical treatment)
Angina:3 years
Syncope:3 years
Dyspnea:2 years
C H F :1.5-2 years
most common cause Of death in AS
CHF
major hemodynamic compensation in Aortic regung
increased LV End Diastolic Volume(preload)
Laplace’s law in Aortic Regurg:
Left vent dilation increases left vent systolic tension required to develop any given level of systolic pressure
rapidly rising ‘water hammer’ pulse which collapses suddenly as arterial pressure falls during late systole and diastole in AR
Corrigan’s pulse
capillary pulsations with alternate Flushing and paling Of the skin at the root of the nail in AR
Quincke’s pulse
Booming pistol shot pulse over the Femoral arteries
Traube’s sign
To and fro murmur audible with light compression of the steth over the femoral artery
Duroziez’s sign
Aortic Regurgitation murmur
high pitched blowing de crescendo diastolic murmur heard best over the 3rd ICS left sternal border
soft rumbling middiastolic bruit in AR
Austin Flint murmur
Optimal Time of Surgery in AR
After Onset of LV dysfunction but BEFORE the onset of severe symptoms
Leading cause of mitral stenosis
Rheumatic Fever
