Valvular heart disease intro (Felner) Flashcards
For Aortic stenosis name:
- primary lesion
- etiology
- valve morphology:
- hemodynamic effect
- severity
- complications
- co-existing lesions
- LV size and function
- aortic stenosis
- bicuspid valve
- calcified
- LVPO
- moderate-severe
- heart block
- aortic regurgitation
- hypertrophied with normal EF
Name three types of aortic stenosis
- valvular (MAJORITY)
- subvalvular
- supravalvular
aortic stenosis produces a _____ murmur
how do you tell whether AS is mild or severe based on murmur?
- systolic; medium-pitch (harsh) with a diamond-shaped
- early peak is mild
- late peak is severe
Give the aortic valve etiology at ages:
0-15
30-60
60-90
50-80
- unicuspid
- bicuspid (AORTOPATHY included.. dilation and aneurysm)
- tricuspid (degenerative)
- tricuspid (rheumatic)
What happens to systolic gradient with aortic stenosis
- decrease gradient
What is hemodynamic effect of AS and what is the compensatory response? what is a consequence to this?
- LV pressure overload
- concentric LVH
- diastolic dysfunction
What is result of concentric LVH initially? how about later?
- initially, we need this adaptation to keep systolic wall-stress normal, while SV/EDV is normal to low… the CO is maintained at rest, but not exercise
Later though, the hypertrophy causes a decreass then LV compliance leading to diastolic dysfunction
What is Laplace’s law
- PR/(2*wall tension)
what are the 3 classic LV outflow tract obstruction ? apply this to aortic stenosis
- Angina – subendocardium
- effort syncope – fixed orifice
- DOE ( dyspnea upon exertion) –> increased pulmonary capillary wedge pressure causing congestive heart failure
physical findings of aortic stenosis
- smaller carotid pulse; the BP is decreased, which gives a narrow pulse pressure
talk about apical impulse location for aortic stenosis
How is it different?
- normal location and size… you have Left ventricular hypertrophy, but no dilation
- takes a lot time to get out the blood because of the hypertrophy and diastolic dysfunction.. WE SEE A SUSTAINED IMPULSE with an S4 sound
How do you know you have a bicuspid valve?
- Ejection sound
S4 indicates ______ why?
- diastolic dysfunction; we’re having problems with filling and getting blood into the ventricle, so we have to kick that shit in
recap of ausculatory sounds for aortic stenosis
- systolic murmur
ES
S2A
S4
what is LV-Ao pull back pressure tracing and what does it show in AS
- pull catheter from LV through aorta out… shows the pressure gradient (high systolic at lV, low at aorta) MAKES THE MURMUR
what are the 5 fingers of determinants of clinical severity for AS
- Carotid pulse – hypokinetic/late peaking
- apex impulse (palpable S4, sustained)
- Ausculation: URSE, late peaking SEM, decerased S2A
- mean gradient >40
- valve area <0.9
what is common cause of aortic coarctation… what does this do for aortic stenosis
- Turner’s syndrome; 50% of cases is BICUSPID`
3 associated abnromalities with aortic stenosis
- coarctation
- mitral annular calcification
- asortic dissection
What are two forms of aortic regurgitation?
- chronic(common) and acute ( emergency)
what are two etiologies of aortic regurg
- intrinsic valve disease
2. aortic root disease (pulls leaflets apart as part of disease)
what are he etiologies of chronic aortic regurg
intrinsic valve: bicuspid valve, rheumatic HD, cusp prolapse
aortic root: marfan, aortic aneurysm, aorititis (syphilis)
What is etiology of acute AR
- intrinsic: endocarditis and trauma
- aortic root disase: aortic dissection/transection
what is pathophysilogy of aortic regurg
- retrograde diastolic flow
- chronic type causes 90% LV volume overload, but also increases afterload a bit
- you get a run off lesion in the aorta… pressure decreases because you’re losing fluid (and therefore pressure) back to left ventricle… so by the time you get to distal aorta, you get decreased afterload
pulse pressure for AR is _____, while for AS it is ______
WIDE
NARROW
Give the compensatory mechanisms for AR and its result o ncompliance and sv
- eccentric hypertrophy due to increased LV end diastolic volume, leading to dilation
- increased LV compliance, resulting in an increased Stroke volume to maintain the CO
what is the difference between LVH in AR and AS
- AR: eccentric (plus dilation)
- AS: concentric (no dilation)
Name symptoms of aortic regurg
- chronic vasodilation (warm skin and diaphoresis)
2. high output state (head bobbing and neck pulsations)
Systolic blood pressure in AR ______
increases
- name two bedside findings of AR.. what is happening with carotid pulse?
- corrigan uplse
- neck pulsations
- bifid carotid pulse due to the HIGH OUTPUT STATE
what is the apex location of AR… describe the apex impulse
- inferolateral and enlarged due to dilation
- apex impulse is actually normal in how long it lasts
what would ejection fraction be potentially in AR
- normal to increased
AR is a ______ murmur; characterize it… what other murmur would we potentially hear?
- holodiastolic murmur
- high pitched (blowing), descrescendo
can potentially see systolic murmur because of the high output state (relative aortic stenosis)
Ejection sound indicates _________
bicuspid valve instead of tricuspid
what is relative aortic stenosis
- basically an “artifact” of aortic regurg; we have problems dealing with high output state, so we see a murmur even though you have a normal valve
name signs of severe aortic regurg
- diastolic murmur + holosystolic murmur
- Austen-flint rumble at the apex… we get mitral valve that’s starting to close because of re-filling and increased pressure… but diastole is still occurring, so we hear the rumble as blood comes across some decrease in space
