Cardiology Pg 296-315
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Questions and Answers

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.

    False

    List one disadvantage of Aortic Valve Replacement (AVR).

    More complications

    A TAVR procedure may be considered when patients have ______ for AVR.

    <p>contraindications</p> Signup and view all the answers

    Match the following features with the correct type of valve used in TAVR:

    <p>Balloon-expandable valve = Expand using a balloon during the procedure Self-expanding valve = Expand automatically upon deployment</p> Signup and view all the answers

    What is the typical surface area of a normal aortic valve?

    <p>3-4 cm²</p> Signup and view all the answers

    A bicuspid aortic valve is associated with a higher incidence of regurgitation than stenosis.

    <p>False</p> Signup and view all the answers

    What are the typical pressures in the left ventricle and aorta during systole?

    <p>120 mmHg</p> Signup and view all the answers

    The aortic valve is referred to as a __________ valve due to its three leaflets.

    <p>tricuspid</p> Signup and view all the answers

    Match the type of aortic valve with its corresponding number of cusps:

    <p>Tricuspid = 3 cusps Bicuspid = 2 cusps Quadricuspid = 4 cusps Unicuspid = 1 cusp</p> Signup and view all the answers

    What is the first symptom associated with aortic stenosis (AS)?

    <p>Angina</p> Signup and view all the answers

    Aortic stenosis is associated with atrial fibrillation, which can be fatal.

    <p>True</p> Signup and view all the answers

    What is the time till onset of syncope in patients with aortic stenosis?

    <p>3 years</p> Signup and view all the answers

    The mnemonic for symptoms of aortic stenosis is _____ 5/3/2.

    <p>ASD</p> Signup and view all the answers

    Match the following findings with their corresponding descriptions:

    <p>Pulsus tardus = Slow rising pulse that reaches desired amplitude Pulses parvus et tardus = Pulse that does not reach desired amplitude Narrow pulse pressure = Associated with left ventricular failure in severe AS High amplitude sustained apex = Caused by left ventricular hypertrophy</p> Signup and view all the answers

    What is the most common cause of aortic stenosis globally?

    <p>Degenerative calcification</p> Signup and view all the answers

    80% of patients with aortic stenosis are female.

    <p>False</p> Signup and view all the answers

    What are the two most common combinations of valvular diseases in rheumatic heart disease?

    <p>Mitral Stenosis (MS) + Mitral Regurgitation (MR) and Mitral Stenosis (MS) + Aortic Regurgitation (AR)</p> Signup and view all the answers

    The process of calcific deposition in aortic stenosis is characterized by infiltration of __________ and hydroxy apatite deposition.

    <p>myofibroblasts</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>AS = Aortic stenosis MS = Mitral stenosis MR = Mitral regurgitation AR = Aortic regurgitation</p> Signup and view all the answers

    What mechanism is responsible for the ejection click associated with the stenosis of a valve?

    <p>Doming motion of valve coming to a halt</p> Signup and view all the answers

    Vascular ejection clicks can be caused by sudden distension of the valve beyond the vessel.

    <p>True</p> Signup and view all the answers

    Where are ejection clicks best heard?

    <p>In the aortic area</p> Signup and view all the answers

    In a patient with mitral valve prolapse, non-ejection clicks are typically associated with ______ during dynamic auscultation.

    <p>long duration murmur</p> Signup and view all the answers

    Match the following classification of ejection clicks with their descriptions:

    <p>Ejection Clicks = Sound produced by opening of semilunar valves Valvular Ejection Click = Heard in aortic stenosis and pulmonary stenosis Vascular Ejection Click = Due to sudden distension of the valve beyond the vessel Non Ejection Clicks = Associated with mitral valve prolapse</p> Signup and view all the answers

    What effect does severe Aortic Regurgitation have on End Diastolic Volume of the Left Ventricle?

    <p>Increased</p> Signup and view all the answers

    Diastolic Blood Pressure (DBP) in aorta may touch zero due to regurgitation in Aortic Regurgitation.

    <p>True</p> Signup and view all the answers

    What sign is considered the surest indicator of wide pulse pressure in Aortic Regurgitation?

    <p>Hill's sign</p> Signup and view all the answers

    In patients with Aortic Regurgitation, resting bradycardia prolongs __________, which worsens the condition.

    <p>Diastole</p> Signup and view all the answers

    Match the following symptoms with their respective condition:

    <p>Angina = Aortic Stenosis Nocturnal Angina = Aortic Regurgitation High Volume Pulse = Aortic Regurgitation Syncope = Aortic Stenosis</p> Signup and view all the answers

    What is the most common congenital valve defect associated with Aortic Stenosis?

    <p>Bicuspid Aortic valve</p> Signup and view all the answers

    Males are more commonly affected by Bicuspid Aortic valve than females.

    <p>True</p> Signup and view all the answers

    What is the risk percentage of sudden cardiac death in severe Aortic Stenosis?

    <p>1%</p> Signup and view all the answers

    The presence of a Bicuspid Aortic valve is associated with a defect in the ______ gene.

    <p>NOTCH-1</p> Signup and view all the answers

    Match the types of Aortic Stenosis with their associated conditions:

    <p>Valvular AS = N/A Subvalvular AS = Hypertrophic cardiomyopathy (HCMP) Supravalvular AS = William syndrome N/A = BAV</p> Signup and view all the answers

    Which type of pulse is characterized by a sharp upstroke and high volume?

    <p>Collapsing pulse</p> Signup and view all the answers

    Pseudocollapsing pulse has a high volume characteristic.

    <p>False</p> Signup and view all the answers

    What are the two types of waves associated with pulsus bisferiens?

    <p>Percussion wave and Tidal wave</p> Signup and view all the answers

    A collapsing pulse is commonly associated with __________.

    <p>aortic regurgitation</p> Signup and view all the answers

    Match the following pulse types with their characteristics:

    <p>Collapsing pulse = Sharp upstroke, high volume Pseudocollapsing pulse = Ill-sustained apex Pulsus bisferiens = Two peaks in systole Normal pulse = Single peak with sustained pressure</p> Signup and view all the answers

    Which characteristic murmur is most commonly associated with aortic stenosis?

    <p>Harsh mixed frequency ejection systolic murmur</p> Signup and view all the answers

    A reverse split S2 is indicative of severe aortic stenosis.

    <p>True</p> Signup and view all the answers

    What is the Sokolov - Lyon criteria for left ventricular hypertrophy (LVH)?

    <p>V5/V6 R wave + VI/V5 S wave &gt; 35 mm</p> Signup and view all the answers

    The aortic arch appears ______ on an X-ray in patients with aortic stenosis.

    <p>dilated</p> Signup and view all the answers

    Match the following heart sounds or findings with their descriptions:

    <p>S3 = Present due to left ventricular hypertrophy and failure S4 = Present due to decreased compliance of the ventricle Ejection Click = Associated with bicuspid aortic valve Gallavardin Phenomenon = Radiation of sound to the apex</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with root-related causes of chronic aortic regurgitation?

    <p>Marfan's syndrome</p> Signup and view all the answers

    Chronic aortic regurgitation can be classified into acute and chronic forms.

    <p>True</p> Signup and view all the answers

    What type of arterial pressure gradient is involved in the pathology of chronic aortic regurgitation?

    <p>Diastolic pressure gradient</p> Signup and view all the answers

    The most common underlying condition that leads to root-related aortic regurgitation is __________.

    <p>syphilis</p> Signup and view all the answers

    Match the following causes of chronic aortic regurgitation with their categories:

    <p>Rheumatic fever = Valvular Marfan's syndrome = Root related Ehlers-Danlos syndrome = Root related Quadricuspid valves = Valvular</p> Signup and view all the answers

    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.
    • 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.

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