Aorta(Mod2)

Front 1

What is the most anterior and postior cusp of the aorta?

Back 1

ant-RCC
post-non(closest to IAS)

Front 2

what are some examples of congenital and aquired aortic valve diseases?

Back 2

Congenital-bicuspid.unicuspid
Aquired-Rhumatic fever; degenerative

Front 3

what is the 1st stage of AO stenosis?

Back 3

LVH

Front 4

What is the difference btw sclerotic and stenotic?

Back 4

Sclerotic-thickened valve, but it opens normally
Stenotic-doesn't open normally

Front 5

What is the most common cusp involved with AO stenosis?

Back 5

RCC

Front 6

What happens to the heart as the AV orifice becomes narrower?

Back 6

-LVH due to increase pressure and afterload.
-LV and LA dialation(become hypokinetic)
-Heart failure

Front 7

what are some cuases of aortic stenosis?

Back 7

bicuspid valve(congenital)
Rhumatic fever(aquired)
degenerative(senile)(aquired)

Front 8

what happens with a bicuspid AV? what are the long term complications of it?

Back 8

-most common cause of AS
-associated with coarctation of the AO.
Long term complications:
-AS, AI, and endocarditis

Front 9

What happens to the AO with rhumatic fever?

Back 9

-associated with mitral disease
-fusion, calcification, and scarring of leaflet edges

Front 10

Degenerative AO stenosis

Back 10

-aging(over65)
-fibrous thickening
-associated with coronary artery disease and conduction problems

Front 11

what are the symptoms of AO stenosis?

Back 11

-Dyspnea and Fatigue
-Angina(coronary artery disease)
-syncope-a and v-fib
-auscultaion-dog bark

Front 12

what are the complications of AS?

Back 12

-sudden death
-pulmonary edema
-myocardial infarcts
-arrythmias

Front 13

What is the 2D and M-mode appearance of AS?

Back 13

-thick AO learflets
-restricted leaflet motion
-LVH
-Systolic doming of the aortic lealets
-post stenotic dialation of AO root
-Decrease LV comliance

Front 14

What doppler measurements should be taken when evaluating for AO stenosis?

Back 14

Peak velocity
pressure gradient
Aortic valve area

Front 15

what should be done to evaluate for AS?

Back 15

-image valve to define causes
-quantify severity
-evaluate co-existing lesions
-Assess LV function

Front 16

How does a patient having low CO produce a false positive for AO stenosis?

Back 16

with low CO, the valve only partially opens, so it may appear stenotic. The solution for this is to have them do a stress test, and if the AVA is still small, then it is a true stenosis.

Front 17

What are the predisposing factors for vegitations

Back 17

-rhumatic disease
-bicustpid AV
-atheromatous changes

Front 18

what does a vegie look like on echo

Back 18

masses or clumps(fuzzy shaggy on ventricular side of valve)

Front 19

what may cause a flail AV?

Back 19

-leaflet destruction by endocarditis, trauma, or high frequency fluttering from AR

Front 20

which way do flail AV leaflets point?

Back 20

LV in diastole, and Aortic root in systole.

Front 21

what does a flail AV look like on m-mode?

Back 21

-eratic systolic leaflet motion
-fluttering leaflets during diastole
-diastole MV flutter w/AI
-enlarged LV in diastole, and AR in systole

Front 22

T/F flail A leaflets will always produce AI?

Back 22

True

Front 23

Aortic dissection:
What is it?
What are the most common causes? What are some other causes?

Back 23

Tear in the intima where a column of blood enters the aortic wall. HIgh mortality rate

Common causes:
-hypertension
-atherosclerosis
-marfans
-pregnancy

Other cuases:
-endocarditis
-syphillis
-trauma

Front 24

With an aortic valve prolapse, what is seen in a parasternal long axis view?

Back 24

posterior placement of the AO leaflet into the LV outflow tract during diastole
-may be associated with MV or TV

Front 25

when would a RCC prolapse occur>

Back 25

with membranous VSD

Front 26

what are the most common locations for an aortic aneursym?

Back 26

-ascending Ao
-aortic arch
-Deascending ao

Front 27

what ar ethe causes of an aortic aneurysm?

Back 27

hypertension and congenital causes

Front 28

Disecting AO aneurysm

Back 28

true lumen of the AO is separated from the false channel by an intimal flap.
-oscullation of the intimal flap can be a sure sign of a dissecting aneurysm

Front 29

how do you delineate btw a true dissection, and an athereosclertic plaque formation?

Back 29

In doppler, the true sumen will demonstrate flow, and false lumen will not.

Front 30

AI

Back 30

-impared valve closure by scar tissue and perforated valve cusps following infection or inflammation are major causes of AI

Front 31

what do we look at with AI?

Back 31

1. backflow=increase forward flow=increased SV
2. intensity of JEt
3. Shape of jet
4. Flow reversal

Front 32

What is the etiology of AI?

Back 32

-rhumatic
-athereosclerotic changes
-infetive endocardiditis
-bicuaspid AV
-aortic valve prolapes
-AO root abnoralities

Front 33

What is an austin flint murmur?

Back 33

jet hitting anteri leaflet of MV-low pitched mid diastolic rumble at apex.

Front 34

WHat happens to the MV with acute AI?

Back 34

MV closes early because pressures are changing quicker.

Front 35

what happens to the MV with chronic AI?

Back 35

the mitral valve closes later because the pressures are slowly changing. THis is why there is the b-bump(increased LV end diastolic pressures)

Front 36

What are the stages of AI?

Back 36

1. LVVO(enlarged hyperdynamic LV)
2. Lage stage-slight LVH
3. Later stage-enlaged poorlymoving LV

Front 37

What does AI look like on M-mode?

Back 37

-diastolic flutter of MV
-DIastolic flutter of AO valve
-LVVO or LVH
-B-bump if chronic

Front 38

What pressure half time would represent mild AI; Severe AI?

Back 38

MIld->400ms
Sever<300ms

Front 39

With severe AI, where is flow reversal seen?

Back 39

-holostolic flow reversal in the proximal AO(seen in subcostal)
-holodiastolic flow reversal in the descending AO(seen in suprasternal notch)

Front 40

what do we use color doppler to look for with AI>

Back 40

-jet width
-jet lenght
-AI jet diameter
-LVOT ratio

Front 41

know pressure curves for MR, MS< AI, and AS.

Back 41

don't forget!!

Front 42

Explain the pressure curve for a Mild aortic regurge compared to one of severe AO regurge?

Back 42

MIlD AI:
-the pressure difference in early diastole is high
-gradient decreases througout diastole due to a decline in diastolic pressure and an increase in LV end diastolic pressure
-(flat slope)
-SEVERE AI:
-aortic pressure drops rapidly during diastole
-LV EDP rises rapidly
-causes rapid slope