Aortic insufficiency/regurgitation

Blood moves backward through the Av from the aort to the LV through diastole

Define aortic insufficiency

Diastole

When does AI occur

Determine etiology, understand Pathophysiology, recognize clinical history, assess LV size and function, measure aortic dimensions, estimate severity of AI

What are the 6 steps of the role of echo in AI

Cuspal abnormalities, aortic root dilation, loss of commissural support

What are the 3 groups of mechanism that can cause AI

Any congenital disorder or disease process that affects the AV cusps

What are cuspal abnormalitites limited to

Congenital abnormalities, rheumatic AV disease, AV prolapse, infective endocarditis

What does cuspal abnormalities include

Infective endocarditis

What is the most common "itis" in the heart

Bicuspid and quadricuspid AV

What are the two congenital abnormalities that can effect the AV

Bicuspid aortic valve

What does BAV stand for

True

T/F: quadricuspid AV is extremely rare

Anomalous coronary artery origin

What is quadricuspid AV associated with

Quadricuspid AV

What does this image represent

Bicuspid AV

What does this image represent

Eccentric closure line of AV suggesting BAV

What does this image represent

Small mass suggesting BAV

What does this image represent

Eccentric AI jet suggesting AI

What does this image represent

Dilated aortic root

What may also be see with a BAV

AI gets worse as patient ages and aortic root dilates

Describe how AI severity can progress

True

T/F: if a patient is born with a BAV it may coapt well when they are younger and not lead to any problems until they are older

Aliasing on the edges of the AV during diastole

Describe edge AI

Quadricuspid AV

What does this image represent

Quadricuspid AV

What does this image represent

X or +

What shape does a quadricuspid usually take on

Bicuspid

Is quadricuspid or bicuspid AV more common

Cusp tissue is infiltrated with fibrous tissue causing them to shorten and retract

What is rheumatic AV disease

MV

What valve is most commonly affected by rheumatic disease

Cusps can no longer properly coapt

Why does rheumatic disease cause regurge or stenosis

True

T/F: rheumatic AV disease is usually associated with some degree or aortic stenosis as well

BAV

Aortic valve prolapse is more common in conjunction with ________

One leaflet slips down below the valve ring during diastole

What is AV prolapse

Aortic root dilation, trauma, rheumatic heart disease, or myxomatous

Besides BAV, what else can aortic valve prolapse be cause by

Vegetation (collection of bacteria cells) destroys the AV

What is aortic bacterial endocarditis

Infection that started somewhere else in the body and travelled to valve

Describe how aortic bacterial endocarditis infects the AV

Endocardial layer

What layer of the heart does bacterial endocarditis infect

Bacterial endocarditis eatin through the AV and abscess is formed

Describe what is happening in this image

Forms "jellyfish strings" which are mobile and can break off and travel, thus leading to PE or stroke

Explain how bacterial endocarditis can lead to a PE or stroke

Hospital forms infections

Where is bacterial endocarditis commonly seen

Infective endocarditis (IE)

What is another term for bacterial endocarditis and its abbreviation

Acute severe

IE is a common cause of _______ __________ AI

Underside of AV (LV side)

What side of the valve is IE found

Destroying one or more cusps

How does IE cause AI

True

T/F: IE can also eat away at the valve and cause holes

Prevents normal leaflet coaptation because too far away

Why does aortic root dilation cause AI

HTN

What is the most notable cause of aortic dilation

Atherosclerosis, connective tissue disorders, bicuspid AV, sinus of valsalva aneurysms, idiopathic

What are some other causes of aorti root dilation

>3.4cm

What mmt of the aortic root indicates aneurysm

Dilated aortic root

What does this image represent

Aortic valves unable to coapt from aortic root dilation

What does this image represent

Layer of the aorta tears

What is an aortic dissection

If dissection occurs in the proximal portion of the aorta it can fall into the AV and prohibit the cusps from coapting

Explain how an aortic dissection can result in aortic regurge

Dissection flap prolapses into valve, causing AI

What does this image represent

Just on the LV side of the AV

Where are membranous VSDs located

Weakens supporting structure of the aortic root and the AV flops into it, causing AI

Explain how VSD's can cause AI

VSD causing AI

What does this image represent

In just a few days

How fast can the "goobers" from infective endocarditis develop

Trauma, infective endocarditis, aortic dissection

What can cause acute severe AI

No

Is there any LVH with acute AI

Filling pressures

Acute severe AI causes and increase in __________________________________

LVEDP

What pressure is most likely to be elevated with acute,severe AI

Because the heart hasn't had time to change shape or thicken in order to compensate for the increases pressure

What does acute, severe AI result in increases filling pressures

Pressure

Acute, severe AI causes a ________________ overload

During diastole, we have the normal inflow PLUS regurge flow from the AI

What does LVEDP increase with acute AI

When LV pressure exceeds LA pressure

When does the MV close (what is happening with the pressures)

LV pressure is increases for AI, so it does not take as long for it to exceed the LA

Why does AI sometimes leave to an early closure of the MV

Normal-slightly elevated

What are the filling pressures like in chronic sever AI

Volume

Chronic AI causes the LV _____________ to increases over time due to stretching

Increased forward flow through the AV

What may this increase in the LV volume result in

Frank starling law

What law predicts that there will be an increase of forward flow with an increase in LV chamber volume

Chamber dilates to try to accommodate it

Why does the LV chamber volume increase overtime with chronic AI

Volume

Chronic severe AI results in _______________ overload

Eccentric hypertrophy

What kind of LV geometry can chronic AI lead to

LV may start to fail at which the LVEDP will increase

Explain what can happen to the heart over a longggg time with chronic AI

Increase in LV and LA size and pressure overload

What is the main complication of AI

Pressure goes backwards from LV into the LA

Why can AI also cause increase in LA size

If pressure in LV very high during diastole, it can cause MR diastolic regurge

Explain what causes diastolic MR from

Will have E wave and might not have A wave

Describe what the waveform of the MR would look like if it has diastolic regurge

Still lets through flow but at some point in diastole the flow becomes regurge

Describe what is happening to the flow in the MV if it has diastolic MR as a result of AI

True

T/F: AI can also lead to pulmonary venous congestions

Pressure continues to back up from left heart into pulmonaries

Explain how AI can lead to pulmonary venous congestion

Pulmonary edema, rt heart failure, systemic venous congestion and edema, embolization

What can pulmonary venous congestion lead to

From the scattered and abnormla flow caused by pulmonary venous congestion

How can pulmonary venous congestion cause embolization

Beta blockers, ACE inhibitors

What are the medications associated with AI

Avoid heavy physical exertion, do not want to add workload

What lifestyle changes may someone with AI may make

Significant, chronic Ai

When is surgical intervention considered for AI

Repair or replacement

What are the two main types of surgeries done for AI

Dilation

What is a repair surgery usually used for

IE, structural problems

What is a replacement surgery used for

SOB, fatigue, edema

What are the general symtpoms of AI

Occasional chest pain

What symptoms is specific to chronic severe AI

Increases LV mass decreases myocardial perfusion causing ischemia

Why may chronic severe AI result in occasional chest pain

Pulmonary edema

What symptom is specific to acute AI

Austin flint

What murmur is specific to severe AI

S3 and S4 from LVH

What other noise may your hear on auscultation with AI

Ventricular arrhythmias, LVH

What findings on the ECG may indicate AI

Cardiomegaly

What finding on a CXR may indicate AI

LVID, LV mass, IVS, PW

What do we measure to assess the LV size

Eccentric

What type of hypertrophy are we looking for with AI

LV volume overload

What does LVVO stand for

LV progressively dilates until it fails and takes on a more spherical shape

Describe what happens to the LV with LVVO from AI

LV more spherical shaped from LVVO

Describe what these images represent