Aortic Stenosis

ruhland1's version from 2016-09-27 15:58

Section 1

Question Answer
can occurabove and below level of aorta
triadchf, loc, angina
risk fasrxctorssmoking, htn, chole, dm, male
AS severitybased on US
Transcatheter A valve replacementif pt is high risk for srx
balloon aortic valvuoplastyonly benefit for a few month
contra in severe dzACEi, nitro, BB
decomp CHFuse nitroprusside, phenylephiphren
sx and w/o repairdeath at 5 yrs 50%, 10yrs 90%
dresden chinaappearance of pallor with light flush
angina + CHF5 yr mort 50% if no srx
why LVH causes anginaarteries do not get bigger
chest px with exertget a cardiac stress test
vent strain patternST-d and T inv, suggest subendocardial isch
syncope3 yr mort 50%
syncope moa1. AS fixes CO, so if dn PVR * dn blood to brain. 2. high pressures in LV cause a vasodepressor response 3. dn blood flow to heart * up arrrythmias
calcific aortic stencan involve electrical conduction
CHF mort50% 2 year mort
systolic dysfunc akadn ejection fraction
diastolic dysfuncaka elevated filling pressure of LV
Heydes syndromeGI bleeding d/t angiodysplasia in colon
VWDAS can break dn VWF
avoid due to periph vasodilnitro, ACEi, terazosin, hydralazine, CO cannot be increased
AS causes50% d/t age related calcification, 30% bicuspid, rhematic fever
AS causes rareFabry, SLE, Paget dz, high uric, infxn
AV opening3-4 cm2
degenerative ASdmg to endothelial cells from mechanical stress, up inflam, up lipoprotein deposition
LV compensationconcentric hypertrophy, in parallel
late stages LVLV dilates, wall thins, dn sysltolic func
pulsus tardus et parvusparvus=pulse, tarus=late (a delayed slow rising carotid upstroke)
delaybetween first heart sound and periphreal pulses
A2softer as more severe
s4stiff ventricle
pulsus bisferienssigns of both AS and AR
AS periph signssustained, heavy apex beat, precordial thrill, narrowed pulse pressure
ekgLVH, calcification can lead to a LBBB
cardiac chamber cathprovides def dignosis
severe stenosisvalve area lt 1.0 cm2, but standard is echo
echocalcs valve area using flow veloitiys, pressure gradient, lt 25 = gt 1,5m gt 70mmhg means lt 0.6
gradient =4(velocity)squared mmhg
cxrshows degree of calcification
mx wo sxget echo and stress every 1-2 years, if severe every 3 to 6 mo
medicationspoor efficacy in tx, use BB for CCB in angina (nitrates contra), htn with BB, CHF with dig and diurectis, ACEi often contra
severe AS standard of careis AV replacement
AV replacement typesopen heart is most common, catheterbased if not srx candidate
balloon valvuloplastyineffective in audlts
mx acute decomp HFmx with intra aortic balloon pump
untx prog of severe AS2 yr mort 50%, 3 year 70%
congential AV repairif unicuspid, make biscupid
aneurysm of ascending aortaleads to AV regurg
candidates for srxdevelop sx, or heart func impaired, or if asx and + stress test
tissue valvehomograft (human) porcine or bovine
Ross procedureAV is replaced with patients own pulmoary valve (used in children)
MAHAcomplic of AS, find hemoglobinuria, need to use warfarin
srxmedian sternotomy, open pericardium, use cardiopulm bypass machine, replace valve, use TEE to verify it is functioning
post srxICU 12-36 hours, go home in four days, recovery in 3 mo, avoid heavy lifting 4-6 mo
post srx complicheart block, may need a pace maker
srx outcomesdeath or serious complic at 1-3%
MICsmin invasive cardiac srx
TAVRtranscath AV replace, delivers mech valce to diseased valve, once in place pushes old valve leaflets out of the way

Section 2

Question Answer
AS murmurup with squat, dn with standing