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14 Cards in this Set
- Front
- Back
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Causes of aortic stenosis |
rheumatic fever calcification/degeneration congenital (bicuspid) post-endocarditis |
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Aortic stenosis: Clinical Presentation |
-sequential triad: 1. chest pain (8 yr) 2. exertional syncope or near syncope (3 yr) 3. dyspnea/orthopnea - CHF (18 mnth)
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Aortic stenosis: physical exam |
-delayed & weakened carotid upstroke ("pulsus tardis et parvis") -late peaking crescendo/descrescendo murmur at base w/ radiations to carotids (murmur at end of systole) -soft/absent S2 (aortic valve stuck close) -hyperdynamic apical impulse (ventricle working very hard to maintain workload) -S4 at apex -mumur may decrease w/ standing (less flow) -significant systolic hypertension (rare) -paradoxic split S2 (aortic closes after pulmonic, at inspiration they close together) -palpable thrill -colonic angiodysplasia & lower GI bleed (rare) |
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What makes murmurs worse (louder/more intense)? |
the amount of flow
(loudest at end of systole, intensity does NOT = severity, it = flow) |
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Aortic stenosis: Test/ Evaluation Findings |
CXR: enlarged LV (or normal) 2d Echo: structure/mobility of valve & thickness./xn of ventricular walls Doppler: quantify gradient & calculate valve area* Cardiac Catherterization ECG: LVH |
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Aortic stenosis MUST be fixed ASAP after onset of angina, mortality in ______ after onset of syncope. mortality in ______ after onset of CHF, mortality in _______
(congenital bicuspid may be asymptomatic (besides ejection click) until calcified) |
angina- 5 yrs syncope- 3 yrs CHF- 18 months
(^ If NOT TREATED) |
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Aortic stenosis: Tx |
-IMMEDIATE surgical intervention (if valve area is 0.75 cm^2) -alternative Balloon valvuloplasty--> for pts who cannot handle open heart surgery |
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Unlike aortic stenosis, ______________, is caused by too much flow through valves, due to some blood being leaked backwards |
aortic regurgitation (insufficiency) |
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Most common cause of aortic regurgitation |
endocarditis
(also rheumatic fever, calfiification, trauma may cause) |
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Aortic root disease also leads to aortic regurgitation (non valvular causes), what leads to aortic root disease? |
cystic medial necrosis marfan's syndrome annulo-ectasia aortic aneurysm/dissection syphylitic aortitis seronegative arthropathies |
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What does the volume overload cause in aortic regurgitation? |
"Cor bovinum"- large, thick-walled heavy, dilated heart (LVH) = good compensation= well tolerated for years |
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Aortic Regurgitation: clinical presentation |
-bounding central pulse (feel pulsation in artery) -diastolic decrescendo murmur -laterally displaced PMI, w/ hyperdynamia, enlargement -anterior heave -wide pulse pressure -Quincke's pulses (see pulsation under finger nails) -Duroziez' sign (brui in systole & in diastole) |
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Aortic Regurgitation: Diagnostic tests |
2D echo: LV chamber dimensinon, wall thickness, motion Doppler: quantification of regurgitant flow left heart catherterization CXR: cardiomegaly ECG: LVH |
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Aortic Regurgitation: Tx |
-Medications for- afterload reduction, ionotropes -Limit stress -Surgery when fxn decrease (ends stystolic of 5cm, diastolic of 7 cm) -If due to root problems--> combine valve/root replacement |
