Podcast
Questions and Answers
What is the main indication for Aortic Valve Replacement (AVR)?
What is the main indication for Aortic Valve Replacement (AVR)?
- History of aortic dissection
- Asymptomatic Aortic Stenosis with LV ejection fraction > 50%
- Severe symptomatic Aortic Stenosis (correct)
- Mild symptomatic Aortic Stenosis
The balloon-expandable valve is used in both AVR and TAVR procedures.
The balloon-expandable valve is used in both AVR and TAVR procedures.
False (B)
List one disadvantage of Aortic Valve Replacement (AVR).
List one disadvantage of Aortic Valve Replacement (AVR).
More complications
A TAVR procedure may be considered when patients have ______ for AVR.
A TAVR procedure may be considered when patients have ______ for AVR.
Match the following features with the correct type of valve used in TAVR:
Match the following features with the correct type of valve used in TAVR:
What is the typical surface area of a normal aortic valve?
What is the typical surface area of a normal aortic valve?
A bicuspid aortic valve is associated with a higher incidence of regurgitation than stenosis.
A bicuspid aortic valve is associated with a higher incidence of regurgitation than stenosis.
What are the typical pressures in the left ventricle and aorta during systole?
What are the typical pressures in the left ventricle and aorta during systole?
The aortic valve is referred to as a __________ valve due to its three leaflets.
The aortic valve is referred to as a __________ valve due to its three leaflets.
Match the type of aortic valve with its corresponding number of cusps:
Match the type of aortic valve with its corresponding number of cusps:
What is the first symptom associated with aortic stenosis (AS)?
What is the first symptom associated with aortic stenosis (AS)?
Aortic stenosis is associated with atrial fibrillation, which can be fatal.
Aortic stenosis is associated with atrial fibrillation, which can be fatal.
What is the time till onset of syncope in patients with aortic stenosis?
What is the time till onset of syncope in patients with aortic stenosis?
The mnemonic for symptoms of aortic stenosis is _____ 5/3/2.
The mnemonic for symptoms of aortic stenosis is _____ 5/3/2.
Match the following findings with their corresponding descriptions:
Match the following findings with their corresponding descriptions:
What is the most common cause of aortic stenosis globally?
What is the most common cause of aortic stenosis globally?
80% of patients with aortic stenosis are female.
80% of patients with aortic stenosis are female.
What are the two most common combinations of valvular diseases in rheumatic heart disease?
What are the two most common combinations of valvular diseases in rheumatic heart disease?
The process of calcific deposition in aortic stenosis is characterized by infiltration of __________ and hydroxy apatite deposition.
The process of calcific deposition in aortic stenosis is characterized by infiltration of __________ and hydroxy apatite deposition.
Match the following terms with their definitions:
Match the following terms with their definitions:
What mechanism is responsible for the ejection click associated with the stenosis of a valve?
What mechanism is responsible for the ejection click associated with the stenosis of a valve?
Vascular ejection clicks can be caused by sudden distension of the valve beyond the vessel.
Vascular ejection clicks can be caused by sudden distension of the valve beyond the vessel.
Where are ejection clicks best heard?
Where are ejection clicks best heard?
In a patient with mitral valve prolapse, non-ejection clicks are typically associated with ______ during dynamic auscultation.
In a patient with mitral valve prolapse, non-ejection clicks are typically associated with ______ during dynamic auscultation.
Match the following classification of ejection clicks with their descriptions:
Match the following classification of ejection clicks with their descriptions:
What effect does severe Aortic Regurgitation have on End Diastolic Volume of the Left Ventricle?
What effect does severe Aortic Regurgitation have on End Diastolic Volume of the Left Ventricle?
Diastolic Blood Pressure (DBP) in aorta may touch zero due to regurgitation in Aortic Regurgitation.
Diastolic Blood Pressure (DBP) in aorta may touch zero due to regurgitation in Aortic Regurgitation.
What sign is considered the surest indicator of wide pulse pressure in Aortic Regurgitation?
What sign is considered the surest indicator of wide pulse pressure in Aortic Regurgitation?
In patients with Aortic Regurgitation, resting bradycardia prolongs __________, which worsens the condition.
In patients with Aortic Regurgitation, resting bradycardia prolongs __________, which worsens the condition.
Match the following symptoms with their respective condition:
Match the following symptoms with their respective condition:
What is the most common congenital valve defect associated with Aortic Stenosis?
What is the most common congenital valve defect associated with Aortic Stenosis?
Males are more commonly affected by Bicuspid Aortic valve than females.
Males are more commonly affected by Bicuspid Aortic valve than females.
What is the risk percentage of sudden cardiac death in severe Aortic Stenosis?
What is the risk percentage of sudden cardiac death in severe Aortic Stenosis?
The presence of a Bicuspid Aortic valve is associated with a defect in the ______ gene.
The presence of a Bicuspid Aortic valve is associated with a defect in the ______ gene.
Match the types of Aortic Stenosis with their associated conditions:
Match the types of Aortic Stenosis with their associated conditions:
Which type of pulse is characterized by a sharp upstroke and high volume?
Which type of pulse is characterized by a sharp upstroke and high volume?
Pseudocollapsing pulse has a high volume characteristic.
Pseudocollapsing pulse has a high volume characteristic.
What are the two types of waves associated with pulsus bisferiens?
What are the two types of waves associated with pulsus bisferiens?
A collapsing pulse is commonly associated with __________.
A collapsing pulse is commonly associated with __________.
Match the following pulse types with their characteristics:
Match the following pulse types with their characteristics:
Which characteristic murmur is most commonly associated with aortic stenosis?
Which characteristic murmur is most commonly associated with aortic stenosis?
A reverse split S2 is indicative of severe aortic stenosis.
A reverse split S2 is indicative of severe aortic stenosis.
What is the Sokolov - Lyon criteria for left ventricular hypertrophy (LVH)?
What is the Sokolov - Lyon criteria for left ventricular hypertrophy (LVH)?
The aortic arch appears ______ on an X-ray in patients with aortic stenosis.
The aortic arch appears ______ on an X-ray in patients with aortic stenosis.
Match the following heart sounds or findings with their descriptions:
Match the following heart sounds or findings with their descriptions:
Which of the following conditions is most commonly associated with root-related causes of chronic aortic regurgitation?
Which of the following conditions is most commonly associated with root-related causes of chronic aortic regurgitation?
Chronic aortic regurgitation can be classified into acute and chronic forms.
Chronic aortic regurgitation can be classified into acute and chronic forms.
What type of arterial pressure gradient is involved in the pathology of chronic aortic regurgitation?
What type of arterial pressure gradient is involved in the pathology of chronic aortic regurgitation?
The most common underlying condition that leads to root-related aortic regurgitation is __________.
The most common underlying condition that leads to root-related aortic regurgitation is __________.
Match the following causes of chronic aortic regurgitation with their categories:
Match the following causes of chronic aortic regurgitation with their categories:
Study Notes
Systolic Added Sounds
- Commonly known as clicks.
Classification of Added Sounds
-
Ejection Clicks:
- Produced by the opening of semilunar valves.
- Valvular Ejection Click:
- Associated with stenosis; abrupt halt of doming valve motion.
- Present in aortic stenosis (AS), pulmonary stenosis (PS), and bicuspid aortic valve (BAV).
- Vascular Ejection Click:
- Results from sudden distension of the vessel; common in vascular aneurysms.
- Associated with increased S₂ sound intensity from vascular pathologies, while valvular issues produce softer S₂.
- Features:
- Absent in severe stenosis due to calcification.
- Best heard in the aortic area; pulmonary clicks better heard on expiration.
-
Non Ejection Clicks:
- Linked to mitral valve prolapse, producing long-duration murmurs.
- Various maneuvers like standing or Valsalva can shift the click closer to S₁.
Treatment of Aortic Stenosis (AS)
-
Aortic Valve Replacement (AVR):
- Bioprosthetic valves are preferred due to fewer complications and no need for anticoagulants.
- Indications include severe symptomatic AS, severe asymptomatic AS with LV ejection fraction <50%, and rapid progression of severity.
- Common disadvantages include complications in elderly patients.
-
Transcatheter Aortic Valve Replacement (TAVR):
- Requires trained cardiologist; a more expensive option.
- Considered for patients who are contraindicated for surgical AVR.
Aortic Stenosis Anatomy
- Aortic valve consists of three leaflets; congenital variations include:
- Bicuspid: Most common with a tendency toward stenosis.
- Quadricuspid and Unicuspid valves also exist.
Clinical Features of Aortic Stenosis
- Symptoms:
- Mnemonic: ASD 5/3/2
- Angina: First symptom due to left ventricular hypertrophy (LVH).
- Syncope: Associated with fixed cardiac output; prevalent after ~3 years.
- Dyspnea: Emerges within ~2 years, linked to elevated LV end-diastolic and pulmonary pressures.
- Mnemonic: ASD 5/3/2
- Timely valve replacement is crucial (within 5 years after symptoms manifest).
Additional Associations and Findings
- Atrial fibrillation and hypertension can complicate AS management.
- Symptoms can escalate to left ventricular failure in very severe cases.
- Pulse Findings:
- In severe AS, blood pressure control is crucial.
- Pulsus tardus and parvus indicative of severe obstruction.
Pathogenesis and Etiology
- Leading causes of AS globally include degenerative calcification and BAV.
- Rheumatic heart disease presents less frequently now but can combine various valvular diseases.
- Aortic sclerosis is found in approximately 30% of elderly patients, often asymptomatic.
Aortic Regurgitation (AR) Overview
- Classified into acute and chronic forms.
Chronic Aortic Regurgitation Causes
- Valvular Leaflet Issues: Rheumatic diseases, congenital defects.
- Root Pathologies: Syphilis, Marfan’s syndrome, and other connective tissue disorders.
Pathophysiology of AR
- Can lead to left ventricular enlargement and increased end-diastolic volume due to backward flow from the aorta.
- Symptoms may arise without warning and worsen with exertion.
Clinical Presentation and Signs
- Wide pulse pressure is characteristic, alongside notable findings such as Hill's sign.
- Collapsing pulses seen in AR and may also overlap with other conditions like patent ductus arteriosus.
Differential Diagnosis: Aortic Stenosis vs Aortic Regurgitation
- AS typically features angina and syncope, while AR causes palpitations and nocturnal angina.
- Symptoms of dyspnea present in both but stem from different hemodynamic issues.
Investigations
- ECG: May reveal left ventricular strain patterns indicative of hypertrophy.
- X-ray: Can show a dilated aortic arch in AS.
- ECHO: Primary tool for diagnosing and assessing severity of aortic conditions.
This overview simplifies complex cardiological concepts related to added sounds, aortic stenosis, and regurgitation, focusing on essential treatments, symptoms, and associated anatomical features.
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Description
Explore the fascinating world of systolic added sounds, specifically ejection clicks, through this quiz. Learn about their mechanisms and the conditions in which they are heard, such as aortic stenosis and aneurysms. Test your knowledge and understanding of cardiac sounds and their implications.
