4.9.2013(valvular Heart Disease) Flashcards
Indications for anticoagulation in patients with MS
MS with AF
MS with previous history of embolism even if pt is in sinus rhythm
MS with LA thrombus
Features of severe MS
Mean gradient of more than 10mm Hg
MVA less than 1cm2
PASP more than 50mm Hg
Drugs useful for rate control in MS
CCB(non dihydropyridine)
Beta blockers
Indications for PMBV
Symptomatic pts with moderate to severe stenosis without contraindications like LA clot or associated MR
Asymptomatic patients with PASP more than 50mm Hg at rest or 60mm Hg with exercise
Hemodynamic results observed after PMBV
Cardiac output increases by 20%
Transmitral gradient decreases by 50%
Valve area increases to 2cm2
Contraindications to PMBV
LA thrombus
MR
Echo score of more than 8
Complications of PMBV
MR
ASD
stroke
Cardiac perforation
Mean survival after development of severe pulmonary hypertension in MS
3 yrs
Aortic sclerosis
Thickening of aortic valve resulting in turbulence and murmur but no gradient
Difference between tricuspid and bicuspid aortic stenosis
Bicuspid stenosis
Presents earlier(60yrs)
More prone for infective endocarditis
Associated with dissection and aneurysms
Presence of opening snap in aortic area
Bicuspid aortic valve
Soft S2(diminished or absent A2)
Severe AS
Severe AS
Peak jet velocity >4m/s
Mean gradient >40mm Hg
Valve area <1cm2
Role of dobutamine stress ECHO in AS
When there is a discrepancy btw valve area and transvalvular pressure gradient
Role of Cath in AS
Symptoms of angina in moderate AS to evaluate for CAD
In pts undergoing AVR at risk for CAD
Rx of severe symptomatic AS
Surgery
No medical Rx
Rx of severe AS with decompensated heart failure
IABP
sodium nitroprusside
Balloon aortic valvuloplasty
Average survival of symptomatic AS pts
3 yrs
Indications for AVR
Severe symptomatic AS
Before CABG in Severe AS pt
Before undergoing Sx on aorta or other valves
Severe AS with LV systolic dysfunction
Most common papillary muscle to rupture in MI
Posteromedial
Acute causes of MR
Ruptured papillary muscles
Ruptured chordae
IE
Causes of MR
Rheumatic MVP Ischemic SLE amyloidosis Congenital(cleft,parachute,fenestrated) HOCM drugs(phen-fen) Para valvular prosthetic leak Mitral annular calcification
Radiation of murmur in MR
Anterior chest wall if posterior leaflet is prolapsed and vice versa
LV dysfunction in MR
EF<60%
Indications for surgery in MR
Symptomatic acute severe MR
Symptomatic chronic severe MR not associated with severe LV dysfunction(55mm
Asymptomatic chronic severe MR with mild to moderate LV dysfunction(EF40mm)
Acute AR
IE
Trauma
Dissection of ascending aorta
Causes of AR
Bicuspid aortic valve RHD Calcific degeneration IE idiopathic dilatation of aorta Myxomatous degeneration Systemic hypertension Dissection of ascending aorta Marfan Trauma AS,RA,reiter,whipple,giant cell aortitis Syphilitic aortitis Discrete subaortic stenosis VSD with prolapse of an aortic cusp
New conduction block in AR
Root abscess
When should drugs be used in pre-hypertension
Evidence of target organ damage or diabetes
Target BP in pts with diabetes or CKD
<130/80
