During a 2D echo, what should be our focus to evaluate for Ai? (What are we eye balling for mainly?)
Aortic Valve, Aortic Root and LV size and function. (Regurgitant jet is also one of them but it wasn’t in the PowerPoint)
Severe Ai is _____ms.
200/250ms
What are the main complications of Acute Ai?
Cardiogenic shock and Pulmonary Edema.
Which valve abnormalities may result with Ai? Name atleast two.
BAV (Congenital), Endocarditis, Rheumatic, Degenerative (acute) , Traumatic (Acute)
True/ False: Ai = Increased SV
True
True/False: Aortic Insufficiency is common.
False: Ai is rare,1% of the population has it and is more common in males under 40yrs.
What valvular changes are caused by Ai? (How can Ai affect the valve leaflets itself.)
Leaflet durability (degeneration), Inadequate coaptation ( leaflets wont close), leaflet perforation (endocarditis or trauma)
What are the most common approaches for visualizing and assessing the jet? (1 for visual and 1 for assessment)
Color Flow and Regurgitant Volume.
1.________ wave will show aliasing due to high velocity.
2.________ wave is needed to obtain full envelope for assessment.
1. Pulse wave
2. Continuous wave
What 2 factors can under or overestimate the regurgitant jet with tachy patients.
Blood Pressure and Heart rate.
What factors may result with Ai? Name atleast two.
Aortic Root Dilitation. Chronic Htn. Marfan Syndrome, Aortic Dissection (acute)
What is the main function of LV with Chronic Ai for compensation? (Chronic)
Hypertrophy (adapt and remodel), Volume and Pressure overload, systolic Htn. (LAE is also possible but it didn’t say in the PowerPoint)
Regurgitant Fraction Equation
(AoV - MV)/ AoV
What are the equations for Regurgitant Volume and Regurgitant Fraction?
RV= SV (av) - SV (mv)
RF= RV/SV(av) x 100%
True/ False: Acute Ai is always considered as medical emergency.
True. LVEDP rises rapidly and SV can’t be maintained despite hearts compensatory mechanism to cope with Regurge volume (preload).
If there is flow reversal in Descending Ao = _______ Ai.
Severe Ai
Values for Severe Ai are; atleast 2 values
LVOT/ Jet area? ROA? PHT? Slope? Regurge Vol? Vena Contracta? Flow reversal?
>60%, >0.3cm2, <200ms (250 in some places), >400cm/s2, >60mL, >0.6cm, Holodiastolic flow. (pg#278)
Define vena contracta and flow convergence.
Vena Contracta is the narrowest part of regurgitation jet behind the valve (>0.6 severe Ai). Flow Convergence is the back flow behind VC.
Indications for surgery values, atleast 2:
EF? LVESD? LVEDD?
<50%, LVESD >5.0cm, LVEDD >6.5cm
What can be deduced from the image shown, that the Aortic Insufficiency is
(a) Mild (b) Moderate (c) Severe
c) Severe (Flow reversal is holodiastolic and rapid decel with steep slope)
What is considered as a normal variant seen in advanced age?
Lambl's Excrescences
True/ False: LVOT utilizes only Continuity Eq.
TRUE