AS Quick Review
What cusp is more commonly involved with AS?
What cusp is more commonly NOT involved with AS?
What velocity are considered to be stenotic for AV?
Greater than 1.9 to 2.0 m/s
What is the definition for sclerotic?
Same thing as stenosis?
Sclerotic is thickened but can still open normally.
NO, stenosis- thickened and can not open normally.
How can we determine between sclerotic and stenosis?
Put CW through and get velocities.
What is Cardiac Index?
CI is a measure of left cardiac output in relation to patient size. Uses BSA not weight.
What will happen to the LV with chronic AS?
What will happen to the EF?
will become thickened, hypertrophied.
Pumping too hard
What will happen to the LV with longtime AS that is not fixed?
What will happen to the EF?
LV will become dilated.
Decrease the EF
Can't pump as hard because dilated.
What will happen to the pressure in the....
LA pressure = increase
LV pressure = increase
AO ROOT pressure = decrease
Where is AS best heard?
right sternal border
What is the severity of the AS murmur based on?
What is it not based on?
based on the longer duration and later the peak of the murmur.
Not based on the intensity of the murmur.
Who is at risk of Degenerative Senile Aortic Stenosis?
person over 65 years
How can AS cause Arrhythmias?
Calification on annulus that can impact Bundle of His
What arrhythmias can AS cause? (3)
1.) ventricular tachycardia
2.) complete atrio-ventricular block
3.) ventricular fibrillation
What will be seen with chronic AS if longtime and not treated so causes the LV to fail? (3)
1.) Dilated AO Root
2.) Dilated, hypokinetic LV
3.) Dilated LA due to long standing LV pressure
What can be measured using Bernoulli's Equation regarding AS?
Maximum instantaeous pressure gradient
Where will the AV/AS velocities be when using the pedoff probe for each?
5 CH= below
SSN = above
RT. Para = above
What is the normal flow in the AV? (3)
1.) Has an early peak during systole.
2.) starts 100 msec after the Q wave on the EKG
3.) Normal velocities range from 1- 1.9 m/s.
Does overestimation happen during low cardiac outputs or high cardiac outputs?
What are 3 things that can cause overestimation and _____cardiac outputs?
High cardiac outputs
3.) Aortic Insufficiency
Does underestimation happen during low cardiac outputs or high cardiac outputs?
What are 3 things that can cause underestimation and ______ cardiac outputs?
Low cardiac outputs
1.) LV failure
3.) > 20 degrees off of parallel to flow
What do you need to be careful of when assessing AS?
2 Differences between
AS could look like MR
1.) AS more pointed, MS more round
2.) AS= 1.9-2.0m/s, MS >5 m/s
Why does MR have a higher velocity that AS?
There is a bigger pressure difference between LV and LA than the LV and the AO.
What two measurement mistakes cause an underestimation of the severity of AS?
1.) Velocities low but really are higher.
2.) AVA bigger but really are smaller.
What two measurement mistakes cause an overestimation of the severity of AS?
1.) Velocities high but really are low.
2.) AVA smaller but really is bigger.
What are two other types of stenosis but really are not considered AS?
1.) Subvalvular aortic stenosis
2.) Supravalvular aortic stenosis
What type occurs below the valve and what type occurs above the valve?
What is Subvalvular aortic stenosis?
What are 4 causes?
obstruction of the LVOT area.
1.) Sigmond septum- most common
2.) Discrete membranous
3.) Diffuse fibromuscular
4.) Struts from a prosthetic valve
What is Supravalvular aortic stenosis caused from...
1.) Membrane supravalvular
2.) Hourglass deformity
3.) Hypoplasis of aorta
What is considered the gold standard for evaluating AS and getting AVA?
Can get accurate pressures
What is considered the 2nd most accurate way to get AVA?
With TEE and trace/planimetry in SAX.
Does not provide accurate on axis velocity measurements in TEE.
What will they often also do during cath lab when checking pressures for AS?
check the coronary arteries to see if need to be fixed also.
What angle is the TEE probe at for PSAX?
What is VTI a measure of?
is a measure of stroke volume.
How much blood is passing through one area in one beat.
What is extremely important when try to get accurate velocity measurements?
be as parallel as possible
What happens when assessing for AS and patient is in AFib?
Need to take many spectral profiles and average them
AS Quick Review