Pathophysiology I

Front 1

What is a narrowing, thickening, and/or obstruction of the Aortic Valve that impedes systolic blood flow traveling from the Left Ventricle through the valve into the Aorta called?

Back 1

Aortic Stenosis

*narrowing, thickening, obstruction

Front 2

What are thickened AoV leaflets that DO open well with a peak velocity of <2 m/s called?

Back 2

Aortic Sclerosis

* OPEN <2m/s

Front 3

True/False:

You CANNOT have a Sclerotic Valve without Stenosis.

Back 3

FALSE

(you CAN have a Sclerotic Valve without Stenosis)

Front 4

What are thickened AoV leaflets that DO NOT open well with a peak velocity of >2 m/s called?

Back 4

Aortic Stenosis

*CLOSED >2m/s

Front 5

What is a harsh Systolic Ejection Murmur called?

Back 5

Aortic Stenosis Murmur

*harsh, systolic, ejection murmur

Front 6

Which type of murmur is Crescendo - Decrescendo in shape and is best heard at the right upper sternal border, which may radiate into the Carotid Arteries?

Back 6

Aortic Stenosis Murmur

*carotid, crescendo/decrescendo, right upper sternal

Front 7

What are 3 causes for Aortic Stenosis?

Back 7

1. Calcific Aortic Stenosis (degenerative AS)
   
2. Congenital Valve Disease(bicuspid/unicuspid)
3. Rheumatic Valve Disease

*CCR

Front 8

Which is the most common Aortic Stenosis?

Back 8

Senile Calcific Aortic Stenosis

Front 9

Which type of Aortic Stenosis originates at the Sinus of Valsalva extending medially towards the AoV cusps, has a fibrocalcific nature and is found most often in patients age 65-70?

Back 9

Senile Calcific Aortic Stenosis

*SofV, AoV, fibrocalcific, 65-70

Front 10

What is the degree of obstruction for systolic separation dependent on to determine if it is mild, moderate, or severe?

Back 10

Area of the Narrowed Orifice

Front 11

What does Severe Aortic Stenosis in an ultrasound image resemble?

Back 11

a Rock Pile

Front 12

What is the normal Aortic Cusp separation?

Back 12

1.5 - 2.6 cm

Front 13

What is the most common CAUSE of AoV Stenosis in patients less than 50 years old?

Back 13

Congenital Aortic Valve Stenosis

Front 14

Which regions could Congenital Aortic Stenosis occur?

Back 14

SubValvular (stenosis)

Valvular (stenosis)

SupraValvular (stenosis)

*SVS

Front 15

What is a congenital membrane across the LVOT called?

Back 15

Fixed SubValvular Obstruction

Front 16

What is Diastolic flutter caused by?

Back 16

Severe Aortic Insufficiency

Front 17

What is the normal velocity of the Descending Aorta?

Back 17

1 m/s

Front 18

True/False:

Doming ALWAYS refers to Stenosis.

Back 18

TRUE

Front 19

True/False:

Aortic Stenosis is visualized as a dagger shaped wave.

Back 19

FALSE

Front 20

What is the Bernoulli Equation?

Back 20

PG = 4(V squared)

Front 21

What is the Continuity Equation?

Back 21

AVA= .785(LVOT squared) x V1 / V2

Front 22

Peak Left Ventricle Pressure equals?

Back 22

Systolic BP + AV Pressure Gradient

Front 23

Left Ventricle End Diastolic Press equals?

Back 23

Diastolic BP - AV Press Gradient

Front 24

True/False:

The BEST view for a SUB-AORTIC MEMBRANE is the Apical 5 Chamber.

Back 24

TRUE

Front 25

When a Doppler examination reveals a high TransAortic Pressure Gradient but the valve anatomy is not clearly Stenotic, What should we suspect the cause to be in a young adult?

Back 25

SubAortic Membrane

*high TransAortic PG

Front 26

True/False:

Aortic Stenosis is a Left Heart Pressure Overload.

Back 26

TRUE

Front 27

Which Scanning Modes allow for detection of the Post-Stenotic flow disturbance and site of the increase in flow velocity at the level of obstruction?

Back 27

Pulsed Wave Doppler and Color Flow Imaging

Front 28

What is an underdeveloped leaflet called?

Back 28

Raphe

Front 29

Which Congenital Aortic Valve has two cusps unequal in size that appear as a football-shaped opening when viewed from the Short Axis View?

Back 29

Bicuspid Aortic Valve

Front 30

Many Bicuspids have _____________ in the larger leaflets, so that the closed valve in diastole appears Tri-leaflet.

Back 30

Raphe

Front 31

Accurate identification of the number of Aortic leaflets can be made only in?

Back 31

Systole

Front 32

The Anterior Leaflet of a Bicuspid Aortic Valve is larger if the leaflet opening is where?

Back 32

AnteroPosterior

Front 33

The Rightward (Right Coronary Cusp) of a Bicuspid Aortic Valve is larger if the opening is where?

Back 33

LateroMedial

Front 34

What is the larger leaflet of a Bicuspid Aortic Valve called?

Back 34

Conjoined Cusp

Front 35

What is the smaller leaflet of a Bicuspid Aortic Valve called?

Back 35

Single Cusp

Front 36

Between which ages does Bicuspid Aortic Stenosis usually become symptomatic?

Back 36

20-50 years

Front 37

What should the patient be evaluated for if they present with Bicuspid Aortic Stenosis?

Back 37

a coexisting Aortic CoArchtation

Front 38

What is the most common method for measuring the Aortic Valve area?

Back 38

Continuity Equation:

AVA = 0.785(LVOT squared) x V1 / V2

Front 39

Regarding the Continuity Equation, what do the following stand for?

AVA

V1

V2

LVOT

Back 39

AVA: Aortic Valve Area

V1: Pulsed Wave Velocity through the LVOT

V2: Peak Velocity through the AV using CW

LVOT: Left Ventricular Outflow Tract diameter

*you can replace VTI for Velocity

Front 40

In which other view can the Aortic Valve Area (AVA) be measured by planimetry (tracing) the AoV orifice in 2D during the maximum opening (at the aortic level)?

Back 40

PSAX

Front 41

True/False:

Aortic Stenosis can be overestimated by high cardiac output states such as Anemia, pregnancy, and Aortic Insufficiency.

Back 41

TRUE

Front 42

True/False:

Aortic Stenosis can be underestimated by low COP states such as Mitral Regurgitation and dysrhythmias.

Back 42

TRUE

Front 43

True/False:

A poor Doppler angle will overestimate the peak velocity through the Aortic Valve.

Back 43

FALSE

(it will UNDERESTIMATE the peak velocity)

Front 44

Why is a Mitral Regurge jet wider than an Aortic Stenosis jet?

Back 44

because the MR jet includes the

-IVCT phase

-IVRT phase

*be careful not to confuse a MR jet and an AS jet

Front 45

What is the NORMAL Aortic Valve Area (AVA)?

Back 45

3-5 cm squared

Front 46

What is the scale for MILD Aortic Stenosis?

• Max Pressure Gradient
• Peak Velocity
• Aortic Valve Area
  

Back 46

Max PG: 16-36 mmHg

Peak Velocity: >3.0 m/s

AVA: >1.5 cm squared

Front 47

What is the scale for MODERATE Aortic Stenosis?

• Max Pressure Gradient
• Peak Velocity
• Aortic Valve Area
  

Back 47

Max PG: 36-50 mmHg
Peak Velocity: 3.0-4.0 m/s
AVA: 1.0-1.5 cm squared

Front 48

What is the scale for SEVERE Aortic Stenosis?

• Max Pressure Gradient
• Peak Velocity
• Aortic Valve Area

Back 48

Max PG: >64 mmHg
Peak Velocity: >4.0 m/s
AVA: <1.0 cm squared

Front 49

The systolic velocity must be evaluated from multiple transducer positions, which are?

Back 49

Apical 5

Suprasternal

Right Parasternal

Front 50

True/False:

When a patient has Aortic Stenosis, it is good to use a PeDoff Probe because it gives more accurate CW Doppler data.

Back 50

TRUE