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44 Cards in this Set
- Front
- Back
What is aortic stenosis? |
Disease of the heart valves in which the opening of the aortic valve is narrowed |
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The aortic stenosis etiology is: |
1. Calcification- age related progressive 2. Congenital- bicuspid aortic valve 3. Rheumatic fever 4. Supra and sub valvular obstructions 5. Prosthetic valve dysfuction |
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List the signs and symptons of AS: |
1. Angina 2. Syncope 3. CHF 4. Systolic ejection murmur- crescendo/decrescendo 5.
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List the pathophysiology of AS: |
1.Systolic pressure overload 2.Increased in LVEDP leading to increased LA pressure 3.Ventricular dysfunction 4. Increased risk for endocarditis
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What is aortic sclerosis? |
valvular thickening by no hemodynamic gradient |
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What are the hemodynamics of AS? |
Increase in afterload --> LV pressure overload
---> incr filling pressure --> LVH (compensatory mechanism) |
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How does decompensation work in aortic stenosis? |
LVF down --> low cardiac output --> increase filling pressure --> heart failure
*Heart failure is caused b/c of persisitent pressure overload leads to deteroration of LVF
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How does Aortic stenosis affect the LA? |
I
Increased LA pressure which causes LA enlargement. |
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How does AS affect the LV? |
Causes LVH, and LV Dilation, and Decreased contractility |
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What part of the heart is not affected by AS? |
Right Atrium |
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2D signs of bicuspid aortic valve: |
Thickened aortic valve leaflets Systolic doming in PLAX (Bicuspid)Football shaped opening of aortic valve in PSAX Coarctation of the aorta LVH |
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2D signs of Degenerative/ Rheumatic: |
increased thickness of AOV decr AOV excursion post-stenotic dilation of ascending aorta LVH increased LV mass Decr LV systolic function (later) LA enlargement
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List the echocardiographic approaches to AS: |
1. Valve anatomy 2. Exclude LVOT obstruction 3. Stenosis Severity 4. Degree of co-existing AI 5. LVH and systolic function |
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What are the ways you calculate AS severity: |
1. LVOT diameter -PLAX 2. LVOT VTI 3. Aortic valve VTI |
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Define continuity equation: |
the flow in one area must equal in the flow in a second area if there are no shunts between the two areas.
LVOT flow = (stenotic ) aortic valve flow |
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What is the Continuity eq? |
AVA (cm2) = LVOT CSA x LVOT VTI/ AV VTI |
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How do you calculated CSA of LVOT? |
CSA (LVOT) = 3.14 x ( LVOT diameter^2) ^2
or CSA = (LVOT diamter)^2 x 0.785 |
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Where is the LVOT measured for AS: |
PLAX in zoom mode, inner diameter just below the AOV |
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Where do you measure LVOT VTI: |
Apical 5 with PW at same level of LVOT diameter |
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How do you calculate aortic valve VTI: |
Parallel to flow Apical 5 or 3 CW through Aortic valve |
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List the aortic valve severity scales: |
Normal 3-5 cm mild: 1.6-2.0 mild to mod: 1.3-1.6 Moderate: 1.0-1.3 Mod to severe: 0.7 -1.0 Severe: <0.7 cm Critical: < 0.5 cm |
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What is the formula for heart pressure gradients? |
Gradient = 4 x Vmax^2 |
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What are gradients influenced by? |
Heart rate and stroke volume |
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What type of jet is indicative of severe aortic stenosis? |
symmetric and rounded-Late peaking doppler signal |
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What type of patients will give you velocities that mimic AS? |
young or anxious, hyperthyroidism, fever, high cardiac output |
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How do i determine between true severe and severe psuedo AS? |
Dobutamine stress echo |
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What causes Paradoxical low flow AS? |
They have AS with small ventricles and CO produces low gradients with severe aortic stenosis. |
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What type of jet will congenital AS have? |
Long eccentric jet |
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What type of jet will a calcific aortic valve have? |
Short jet with spray |
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Low gradients in severe AS/normal EF are: |
AVA < 1.0 cm EF > 50% Mean gradient < 40 mmHg |
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How is Aortic Stenosis and Aortic Regurgitation related? |
1. Simultaneously 2. Common in bicuspid valves 3. Significant aortic regurgitation leads to higher gradients |
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What does significant AR lead to AS in quantification of aortic stenosis? |
Overestimation of the severity of AS |
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How do I not confuse MR with AS jet? |
MR is longer because there is no flow during IVRT/IVCT throught aortic valve |
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What are the mild values for aortic stenosis? |
Jet velocity: <3 (m/s)
Mean gradient: 25 mmhg
Area: >1.5 cm |
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What are the moderate valves for AS? |
Jet velocity: 3-4 (m/s)
Mean gradient: 25-40 mmhg
Area: 1-1.5 cm^2
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What are the values for severe AS? |
Jet velocity: >4
Mean gradient: 40 mmhg
Area: <1 |
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What are the other pathologies of aortic stenosis? |
1. Subvalvular aortic stenosis 2. Supravalvular aortic stenosis |
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What is subvalvular aortic stenosis? |
congential membrane or ridge in LVOT beneath AOV
-need TEE |
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2D characteristic of subvalvular membrane: |
Congential membrane Early systolic closure of aortic leaflets LVH |
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What is supravalvular stenosis? |
Muscular ridge w/ a membrane causing obstruction is seen in LVOT
-LVH
-PLAX- (best view)
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List the three types of supravalvular stenosis: |
1. Hourglass 2. Membranous 3. Tubular |
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Dopper signs for supravalvular stenosis: |
increased velocity & turbulence at level of obstruction measure peak gradients Use Continuity eq for valve area Check for AR Use PW/Color flow to locate level of obstruction |
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What does subvalvular obstruction lead to? |
Aortic valve destruction and AI |
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What are the options to fix AS? |
TAVR - severe/symptomatic patients |