CC Jan 2018 Aortic stenosis

echoecho's version from 2018-03-08 09:00


Question Answer
Aortic stenosis (AS) affects up to ___% of adults over the age of 65?3
AS is characterized by obstruction of blood flow across the ____ valve?aortic
What is the most common etiology of AS? There is a similar pathophysiology to that of what type of disease?1) degenerative disease of the valve 2) atherosclerotic heart disease
What are other causes of AS? 1) congenital abnormalities (bicuspid aortic valve) 2) rheumatic fever
AS has a long ____ phase when compensatory left ventricular hypertrophy overcomes the increased pressure across the aortic valve and maintains adequate flow into the aorta?latent
Over time, these compensations fail and what can become impaired and what results happen?systolic function can become impaired leading to systolic heart failure and often associated diastolic heart failure
When the above occurs, what symptoms can the patient get?1) angina (due to poor perfusion of the coronary arteries) 2) dyspnea on exertion 3) syncope
What is the physical exam finding?harsh, late-peaking systolic murmur that is best heard at the right sternal border, the second intercostal space that radiates into the carotid arteries
When AS is suspected, what is the initial test of choice?TTE
What 3 findings help to classify the severity of AS?1) transaortic velocity 2) mean pressure gradient 3) aortic valve area
In 2014, ACC/AHA guidelines recommended a _____ system for valvular heart disease (including AS) that can be used to guide intervals for TTE and treatment?staging
Recommended TTE intervals for AS (stage B with mild AS) are every ____ to ____ years?3; 5
Recommended TTE intervals for AS (stage B with moderate AS) are every ____ to _____ years?1; 2
Recommended TTE intervals for AS (stage C AS) are every ____ to ____ months?6; 12
What medical condition should be treated because it contributes to increased risk of ischemia and mortality?HTN
True or false? Blood pressure goals are similar to those in the general population?true
If the left ventricular chamber size is small, what should be avoided because this can cause reductions in cardiac outputs?diuretics
Have statins been shown to have specific benefit in patients with AS?no; however, are often indicated for co-existing dyslipidemia
What other modifiable cardiac risk fxs should be addressed?1) DM 2) tobacco use
*** List the 3 indications for aortic valve replacement?1) symptomatic aortic stenosis (syncope, presyncope, heart failure or angina) 2) asymptomatic severe aortic stenosis with an abnormal exercise stress test 3) moderate aortic stenosis in patients who are scheduled to undergo other cardiac surgery (CABG)
*** The 2014 ACC/AHA guidelines were recently updated and now recommend aortic valve replacement for asymptomatic SEVERE aortic stenosis regardless of ventricular function (stage C), if the surgical risk is low or intermediate. True or false?true
List the two types of approaches that a aortic valve can be replaced? Which one is preferred for symptomatic patients with indications for surgical replacement but who are at high risk for an open approach?1) open 2) trancatheter approach ( TAVR) 3) TAVR
What type of valves are recommended for pts of all ages who are unable to undergo long term anticoagulation? What type of valves are preferred for patients younger than 60 y.o.?1) bioprosthetic valves 2) mechanical valves
Currently only ______ valves are used in TAVR?bioprosthetic
In patients with prosthetic valves, what medication is recommended? Are direct oral anticoagulants recommended?1) Warfarin 2) no
What is the INR goal for patients with aortic valve replacement?3 +/- 0.5
If a bioprosthetic valve is used, Warfarin is used for____ to ____ months after surgery? Why?1) 3; 6 2) because evidence suggests that this may reduce the risk of post-procedure stroke
Do patients who have undergone valve replacement require infective endocardiatis prophylaxis during high-risk procedures?yes
Compare transaortic velocity (meters per second), mean pressure gradient (mmHg) and aortic valve area (cm3) as to normal echo, mild AS, moderate AS, severe AS?1) Transaortic velocity (meters per second) = normal (< 2); mild AS (2 - 2.9); moderate AS (3 - 3.9); severe (>4) 2) mean pressure gradient (mmHg) = normal < 10; mild AS 10-19; moderate AS 20-39; severe AS > 40 3) aortic valve area (cm3) = normal 3-4 ; mild AS 1.5-2.9; moderate 1-1.4; severe < 1
List the ACC/AHA staging of valvular heart disease with description of each?1) stage A (at risk = risk fxs are present for the development of valvular heart disease) 2) stage B (progressive = mild to moderate disease severity and asymptomatic) 3) stage C (asymptomatic severe = C1 --> asymptomatic patients with severe valvular disease and compensated ventricular function; C2 ---> asymptomatic patients with severe valvular disease and decompensated ventricular function 4) symptomatic severe = patients with symptoms due to valvular heart disease
*** SUMMARY = What is the most common etiology of AS and has a similar pathophysiology to that of atherosclerotic heart disease?degenerative disease of the valve
*** SUMMARY = AS is slowly _______ but well tolerated in early stages. Close monitoring with ______ is indicated?1) progressive 2) ultrasound
*** SUMMARY = List the indications for surgery?1) severe symptomatic disease OR 2) severe asymptomatic disease among patients at low or intermediate surgical risk
*** SUMMARY = What approach is a much less invasive approach then open-heart surgery and is indicated in symptomatic high-risk patients?transcatheter aortic valve replacement