M2-C5-L46 --> Aortic Valve Diseases

Front 1

VALVULAR DZ OVERVIEW

- Prevalence of Valvular Dz (give %)

- Prevalence increases with?

- Gender preference?

Back 1

> 5 million (> 2.5%)

- age

- Males

Front 2

VALVULAR DZ OVERVIEW

- Prevalence & presentation shoots up after what age?

Back 2

- 65 y.o.

Front 3

VALVULAR DZ OVERVIEW

- Stenosis is failure of?

- effects of blood flow how?

Back 3

- opening completely

- impedes forward flow

Front 4

VALVULAR DZ OVERVIEW

- Regurgitation/Insufficiency is a failure of?

- Effect on blood flow how?

Back 4

- closing completely

- allows reverse flow (back leakage)

Front 5

VALVULAR DZ OVERVIEW

- Clinical Consequence depends on what 4 things?

Back 5

(DR CV)


- Degree of Impairment
- Rapidity

- Compensatory mechanism rate & quality
- Valve involved

Front 6

SECONDARY CHANGES

- secondary changes for Aortic valve problems

Back 6

- LVH

Front 7

SECONDARY CHANGES

- secondary changes for Mitral valve problems

Back 7

- LA Dilation

- Reactive Pulmonary HTN

Front 8

VALVULAR INSUFFICIENCY

- Valvular Insufficiency is in an Intrinsic Dz of what?

- Acute or chronic?

- what structures are affected?

Back 8

- Valve cusps

- Acute or Chronic

- Supporting structures are damaged or distorted

Front 9

VALVULAR STENOSIS

- Valvular Stenosis is primarily a disease of what?

- Acute or Chronic?

Back 9

- Cusp abnormality

- Chronic

Front 10

ADAPTATION

- Heart adaptation to valvular dysfunction depends on what 2 things?

Back 10

- Severity of Valve

- Valve involved

Front 11

ADAPTATION

- Adaptation depends on Severity of Valve. What factors are involved under it? x2

- Adaptation depends on Involved Valve. What factors are involved under it? x2

Back 11

- Onset
- Progression rate

- if Aortic: then LVH
- if Mitral: then LAD

Front 12

ADAPTATION

- Pressure overload is associated w/ what valvular dysfunction?

- Compensatory MECHANISM

- manifest in heart?

- when do you see symptoms?

Back 12

- Stenosis

- Concentric hypertrophy

- LVH with Aortic dysfunction

- when Decompensated

Front 13

ADAPTATION

- Volume overload is associated w/ what valvular dysfunction?

- Compensatory MECHANISM

- manifest in heart?

- when do you see symptoms?

Back 13

- Regurgitation / Insufficiency

- Eccentric Hypertrophy

- LVH & LV Dilation

- Decompensated = symptoms

Front 14

ADAPTATION

- Eccentric is what overload?

- Describe Eccentric left ventricle

Back 14

- Volume overload

- LVH & LAD

Front 15

ADAPTATION

- Concentric is what overload?

- Describe Concentric left ventricle

Back 15

- Pressure overload

- LVH

Front 16

ADAPTATION

- Stenosis involves what hypertrophy

- Insufficiency involves what hypertrophy

Back 16

- Concentric

- Eccentric

Front 17

AORTIC VALVE DISEASE

- define Aortic Valve Sclerosis

Back 17

- Thickening of cusps WITHOUT stenosis

Front 18

AORTIC VALVE DISEASE

- define Aortic Valve Stenosis

Back 18

- Narrowing of valve with problems opening

Front 19

AORTIC VALVE DISEASE

- define Aortic Valve Regurgitation

Back 19

- insufficiency due to problems closing

Front 20

AORTIC SCLEROSIS

- Define

Back 20

- Aortic Valve Thickening withOUT Stenosis

Front 21

AORTIC SCLEROSIS

- ECHO features x3

Back 21

(CSF)

- NO Commisural Fusion
- NO Significant Obstruction

- Focal Areas of Thickening

Front 22

AORTIC SCLEROSIS

- Common in what population groups? x2

Back 22

- Elderly

- African Americans (8%)

Front 23

AORTIC SCLEROSIS

- what study showed the associated link of Aortic Sclerosis to Middle aged African Americans?

Back 23

- ARIC study

Front 24

AORTIC SCLEROSIS

- Common Dz association

- Common association seen in EKG

- Common association seen in Hemodialysis (HD)

Back 24

- HTN

- LVH

- ESRD

Front 25

AORTIC SCLEROSIS

- Almost half of the people with Aortic Sclerosis is in what population group?

Back 25

- over 80 y.o.

Front 26

AORTIC SCLEROSIS

- what is seen on the Aortic valve on gross exam with Aortic Sclerosis?

Back 26

"Bone-like" calcifications
on
Aortic side
of
Leaflet

Front 27

PROGRESSION

- Mild Stenosis jet velocity?

- Moderate Stenosis jet velocity?

- Severe Stenosis jet velocity?

Back 27

- 2 to 3 m/s

- 3 to 4 m/s

- > 4 m/s

Front 28

PROGRESSION

- what is the average time interval to Severe stenosis?

Back 28

- 8 years

Front 29

AORTIC STENOSIS

- what are the 3 classification

Back 29

- Valvular Dz

- Supravalvular Dz

- Subvalvular Dz

Front 30

AORTIC STENOSIS

- 3 subtypes of Valvular

Back 30

- Congenital

- Calcific

- Rheumatic Heart Dz (rare)

Front 31

AORTIC STENOSIS

- Valve involved in Congenital type

- Valve involved in Calcific type

Back 31

- Bicuspid valve

- Tri-leaflet valve

Front 32

AORTIC STENOSIS

- which classifications of Aortic stenosis does NOT involve valves nor valve cusps?

Back 32

- only Valvular Dz involves Valves
(hence the name jackass)

Front 33

AORTIC STENOSIS

- characters of Supravalvular Dz in Aortic Stenosis x2

Back 33

- Long Diffuse Narrowing

- Hourglass deformity (65-70%)
(of ascending aorta)

Front 34

AORTIC STENOSIS

- characters of Subvalvular Dz in Aortic Stenosis? x2

Back 34

- Thin membrane involvement
or
- Thick membrane involvement

Front 35

AORTIC STENOSIS

- what type of valve is associated with Younger people?

Back 35

- Biscuspid Aortic Valve

(like in congenital)

Front 36

AORTIC STENOSIS

- what type of valve is associated with Elderly people?

Back 36

- Calcific Aortic Stenosis

Front 37

AORTIC STENOSIS

- LVH associated with Aortic Stenosis is a Systolic or Diastolic Dysfunction?

- what ability is impaired?

Back 37

- Diastolic Dysfunction
(systolic is ok)

- Impaired Relaxation

Front 38

AORTIC STENOSIS

- once decompensation sets in, what 3 diseases do you get and list them in order of worst to best in terms of prognosis.

Back 38

1.) HF

2.) Syncope

3.) Angina

Front 39

AORTIC STENOSIS

- once HF, Syncope, or Angina sets in, what can be done to prolong life?

Back 39

- Aortic Valve replacement

Front 40

AORTIC STENOSIS

- List the major 6 symptoms

Back 40

(DASH)

- Dyspnea, Orthopnea, PND

- Angina pectoris

- Synchope

- HF

Front 41

AORTIC STENOSIS

- Symptoms of Dyspnea, Orthopnea, and PND is due to?

Back 41

- Diastolic Dysfunction

Front 42

AORTIC STENOSIS

- Symptoms of Angina Pectoris is due to?

Back 42

- Impaired Coronary Blood Flow in Hypertrophied Ventricle

Front 43

AORTIC STENOSIS

- Syncope symptom is what type?

- due to? x2

Back 43

- Exertional Syncope

- Arrhythmia
or
- Heart block

Front 44

AORTIC STENOSIS

- HF symptoms prognosis?

Back 44

- 50% die in 1 to 2 years if not Tx'd

Front 45

AORTIC STENOSIS

- List the signs elicited on PE. x5

Back 45

(DSSSS)

- Delayed Carotid Upstroke

- SEM

- Soft single S2

- Sustained Apex beat

- S4

Front 46

AORTIC STENOSIS

- which Sign is the most reliable sign to gauge severity?

Back 46

- Delayed Carotid Upstroke

Front 47

AORTIC STENOSIS

- why do you see an S4?

Back 47

- reduced LV compliance

Front 48

AORTIC STENOSIS

- EKG would show what? x2

- CXR would show waht? x2

Back 48

- LVH
- Rhythem

- Dilated root
- Calcification

Front 49

AORTIC STENOSIS

- ECHO to assess?

Back 49

(ECHO AS E-CASA)
- EF
- Calcification of Valve
- Appearance of Valve
- Severity
- Area of Valve

Front 50

AORTIC STENOSIS

- Cardiac Catheterization would show what?

Back 50

(AS CC goes to PGA)

- Pressures
- Gradient
- Area of Valve

Front 51

AORTIC STENOSIS

- Palliative Tx involves what MEDS?

- Palliative Tx involves what Procedure?

Back 51

- Digoxin & Diuretics to improve CHF

- Balloon Valvuloplasty
(temporary relief)

Front 52

AORTIC STENOSIS

- Curative Tx involves what MEDS?

- Curative Tx involves what Procedure?

Back 52

- No meds

- Aortic Valve replacement

Front 53

AORTIC STENOSIS

- in aortic valve replacement, what are the 3 types of valves that can be used?

Back 53

(HMB)

- Homograft

- Mechanical

- Bioprosthetic

Front 54

AORTIC INSUFFICIENCY

- list he 4 categories?

Back 54

- Valve Cusp

- Aortic Root

- Aortic Root & Valve Cusp

- SubValvular

Front 55

AORTIC INSUFFICIENCY

- Etiologies involved in Valve Cusp AI. x4

Back 55

(BIRD)

- Bicuspid Valve involved
- Infective Endocarditis
- Rheumatic
- Degenerative

Front 56

AORTIC INSUFFICIENCY

- Causes of Aortic Root AI x2

Back 56

(ED needs to get to his roots)

- Ectasia
- Dissection

Front 57

AORTIC INSUFFICIENCY

- Causes of Aortic Root & Valve Cusps AI x2

Back 57

(MC)

- Marfan
- Collagen Vascular Dz

Front 58

AORTIC INSUFFICIENCY

- Causes of SubValvular AI x2

Back 58

(Sub-Val-VularS)

- Sinus of Valsalva Aneurysms

- VSD

Front 59

AORTIC INSUFFICIENCY

- list the sequential steps in pathophysiology x5

Back 59

(ALES - LV)

- Aortic Insufficiency

- LV Volume overload

- Eccenctric LVH

- Systolic Pressure increase

- LV Dysfunction

Front 60

AORTIC INSUFFICIENCY

- is the LV dysfunction in AI systolic or diastolic?

Back 60

- Systolic in AI

(Diastolic in AS)

Front 61

AORTIC INSUFFICIENCY

- compare symptoms of AI to AS

- what symptom is very uncommon in AI but is common in AS?

Back 61

- Similar

- Syncope

Front 62

AORTIC INSUFFICIENCY

- AI is associated with Increased Systolic Pressure, but is there a diastolic component in AI?

Back 62

- yes, thus the Dyspnea, Orthopnea and PND

(caused by Diastolic Dysfunction due to LVH)

Front 63

AORTIC INSUFFICIENCY

- Chronic AI murmurs x2

- Acute AI murmurs

Back 63

- Austin Flint murmur
- Diastolic murmur

- Short Diastolic murmur

Front 64

AORTIC INSUFFICIENCY

- Signs in PE for Chronic AI x5

Back 64

(PHD & DA murmurs)

- Pulse pressure wide
- Hyperdynamic
- Displaced LV impulse

- Diastolic murmur (high pitched)
- Austin Flint murmur (low pitched)

Front 65

AORTIC INSUFFICIENCY

- Signs in PE for Acute AI x4

Back 65

(STS - S)

- Small Pulse
- Tachycardia
- SV reduction

- Short Diastolic murmur

Front 66

AORTIC INSUFFICIENCY

- EKG shows?

- CXR shows?

Back 66

- LVH

- Cardiomegaly
- Pulmonary Congestion in Acute AI

Front 67

AORTIC INSUFFICIENCY

- ECHO reveals x5

Back 67

- Mitral pre-closure
- Valve Anatomy
- AI quantification

- LV size
- LV function

Front 68

AORTIC INSUFFICIENCY

- Cardiac Cath reveals what? x2

Back 68

- Coronary Anatomy
- Assessment of AI

Front 69

AORTIC INSUFFICIENCY

- Medical treatment is given to which patients/

- Medical treatment with what meds? x2

Back 69

- Mild to Moderate symptoms

- Diuretics
- Vasodilators

Front 70

AORTIC INSUFFICIENCY

- Surgical Treatment indications? x3


- what is the Surgical Tx?

Back 70

(SEC Surgery )
- Severe AI
- EF < 55%
- Cardiac enlargement

Aortic Valve Replacement

Front 71

PROSTHETIC VALVES

- list 2 types of mechanical valves

Back 71

- Caged ball

- Disc

Front 72

PROSTHETIC VALVES
COMPARE (DOTS)
MECHANICAL vs. BIOPROSTHETIC

- Durability

- Orifice

- Thromboembolic potential

- Site thats best!

Back 72

Mechanical is durable
(Bio is not)

Mechanical has Large orifice
(Bio is small orifice)

Mechanical has High Thromboembolic potential
(Bio is small)

Mechanical: Left side
(Bio: Tricuspid)