Bicuspid Aortic Valve
What anatomical defect causes early calcification in a young patient?
Bicuspid aortic valve
Aortic stenosis is a type of left ventricular ________.
Outflow obstruction
What heart sound can be heard from diastolic heart failure?
S4
In a patient with aortic stenosis, chronic bleeding from fragile colonic vessels can lead to this laboratory finding. (Also seen in our patient).
Low hemoglobin
What type of heart failure is caused by aortic stenosis?
Diastolic
How are the calcium levels in dystrophic calcifications?
Normal
Although this medication class does not fix the valve narrowing in aortic stenosis, it is often used to relieve pulmonary congestion and symptoms of fluid overload in patients with left ventricular diastolic dysfunction.
Diuretics
The aortic stenosis murmur is best auscultated in.....
the right 2nd intercostal space
Chronic GI bleeding from angiodysplasia in Heyde syndrome most commonly leads to:
Iron deficiency anemia
The equation for ejection fraction is?
SV/EDV
What test would you order to screen relatives of a patient with a bicuspid aortic valve?
Echocardiography
What pattern determines left atrial enlargement on ECG?
Biphasic P wave, P mitrale
1. Lead II – “P mitrale”
2. Lead V1 – Biphasic P wave
The aortic stenosis murmur radiates to....
the carotids.
This definitive treatment reverses the underlying pathophysiology by eliminating the shear stress on vWF.
Aortic valve replacement
What are the two most common causes of diastolic heart failure?
Aortic stenosis and hypertension
What is the inheritance of bicuspid aortic valve? State the 3 characteristics.
Autosomal Dominant. Incomplete Penetrance. Variable Expressivity.
The classic triad of aortic stenosis is:
exertional dyspnea, angina, and syncope
Angina without atherosclerosis due to increased myocardial demand from the high pressures generated.
An aortic stenosis murmur is best heard with..... (think breathing).
Expiration
Loss of large vWF multimers impairs platelet adhesion, particularly in this type of high-flow vascular lesion.
Angiodysplasia
Diastolic heart failure causes blood to back up into ______ and ______.
The left atrium and the lungs.
What gene is most associated with bicuspid valve stenosis?
Most associated with NOCTH1 gene + TGF-B epigenetic alterations
“In aortic stenosis, increased left ventricular pressure from outflow obstruction produces this classic carotid pulse finding characterized by a weak and delayed upstroke.”
pulsus parvus et tardus
Heart sound generated by aortic stenosis. (Not heart failure)
Single S2, harsh crescendo-decrescendo systolic ejection murmur
High shear stress across a stenotic aortic valve causes proteolysis of this key platelet adhesion protein.
von Willebrand factor (vWF).
How are sarcomers added in concentric heart failure?
In parallel
Concentric hypertrophy is due to pressure overload.
The heart wall thickens while the chamber size remains relatively normal > stiff ventricle with normal EDV > decreased compliance with maintained stroke volume > Ejection fraction remains normal