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ACC/AHA Guidelines > ACC AHA Part 2 > Flashcards

ACC AHA Part 2 Flashcards

1
Q

ACC AHA 2014 Recommendations for Medical Therapy for Aortic Regurgitation

1.

A
  1. Class 1
    1. Treatment of hypertention (BP > 140 mmHg) is recommended in patients with chronic AR
      1. Preferably with DHPR- CCB or ACE/ARB
  2. Class IIa
    1. ACE/ARB and beta blockers is reasonable in patients who has symptoms and /OR LV dysfunction, when surgery is not performed because of comorbidities
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2
Q

2014 ACC/AHA Class I reccomendations for surgery for Aortic Regurgitation

A

2014 ACC/AHA Class I reccomendations for surgery for Aortic Regurgitation

  1. Class I
    1. AVR is indicated for symptomatic patients with severe AR regardless of LV systolic function
    2. AVR is indicated for asymptomatic patient with chronic severe AR and LVEF < 50%
    3. AVR is indicated for patients with severe AR who are undergoing Surgery for other indications
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3
Q

ACC/ AHA 2014 Recommendation for Surgical therapy for Aortic Regurgitation

  1. Class IIa Recommendations
A
    1. AVR is reasonable for asymptomatic patients with severe AR, Normal LV systolic function (LVEF > 50%) but severe LV dilation (LVESD > 50mm)
    2. AVR is reasonable in patients with moderate AR undergoing other cardiac surgery (IIa)
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4
Q

ACC/ AHA 2014 Recommendation for Surgical therapy for Aortic Regurgitation

Class IIb Recommendations

A

ACC/ AHA 2014 Recommendation for Surgical therapy for Aortic Regurgitation

  1. Class IIb Recommendations
    • AVR may be considered for asymptomatic patients with severe AR, Normal LV systolic function (LVEF > 50%) but with progressive LV dilation (LVEDD > 56mm) if surgical risk is low)
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5
Q

Reccomendation for

symptomatic patients with severe AI

A

AVR is indictated regardless of LV function for symptomatic patient with severe AR

Class 1 indication ACC/AHA (2014)

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6
Q

Echo / Hemodynamic Classification of mild Aortic insufficiency

  1. Jet width
  2. Vena contracta
  3. RVol
  4. RF
  5. ERO
  6. Angiography grade
A
  1. Jet width <25% of LVOT
  2. Vena contracta <0.3 cm
  3. RVol <30 mL/beat
  4. RF <30%
  5. ERO <0.10 cm2
  6. Angiography grade 1+
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7
Q

Echo / Hemodynamic Grading of mild AI

  1. Jet width ?
A

Echo / Hemodynamic Grading of mild AI

  1. Jet width <25% of LVOT
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8
Q

Echo / Hemodynamic Grading of mild AI

Vena contracta?

A

Echo / Hemodynamic Grading of mild AI

Vena contracta <0.3 cm

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9
Q

Echo/ Hemodynamic grading of mild Aortic insufficiency

  1. RVol ?
A

Echo/ Hemodynamic grading of mild Aortic insufficiency

  1. RVol <30 mL/beat
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10
Q

Echo/ Hemodynamic grading of mild Aortic insufficiency

RF ?

A

Echo/ Hemodynamic grading of mild Aortic insufficiency

RF <30%

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11
Q

Echo/ Hemodynamic grading of mild Aortic insufficiency

ERO?

A

Echo/ Hemodynamic grading of mild Aortic insufficiency

ERO <0.10 cm2

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12
Q
  • Hemodynamic / Echo criteria for Moderate AR?
    1. Jet width
    2. Vena contracta
    3. RVol
    4. RF
    5. ERO
    6. Angiography grade
A
  • Hemodynamic / Echo criteria for Moderate AR?
    1. Jet width 25%–64% of LVOT
    2. Vena contracta 0.3–0.6 cm
    3. RVol 30–59 mL/beat
    4. RF 30%–49%
    5. ERO 0.10–0.29 cm2
    6. Angiography grade 2+
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13
Q

Hemodynamic / Echo criteria for Moderate AR?

Jet width ? % of LVOT

A

Hemodynamic / Echo criteria for Moderate AR?

Jet width 25%–64% of LVOT

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14
Q

Hemodynamic / Echo criteria for Moderate AR?

Vena contracta ?

A

Hemodynamic / Echo criteria for Moderate AR?

Vena contracta: 0.3–0.6 cm

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15
Q

Hemodynamic / Echo criteria for Moderate AR?

RVol?

A

Hemodynamic / Echo criteria for Moderate AR?

RVol: 30–59 mL/beat

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16
Q

Hemodynamic / Echo criteria for Moderate AR?

RF ?

A

Hemodynamic / Echo criteria for Moderate AR?

RF 30%–49%

17
Q

Hemodynamic / Echo criteria for Moderate AR?

ERO ?

A

Hemodynamic / Echo criteria for Moderate AR?

ERO 0.10–0.29 cm2

18
Q
  • Hemodynamic/Echo criteria of Severe AR:
    1. Jet width
    2. Vena contracta
    3. Abdominal aorta flow ?
    4. RVol
    5. RF
    6. ERO
      1. Angiography grade
A
  1. Severe AR:
    1. Jet width _65% of LVOT
    2. Vena contracta >0.6 cm
    3. Holodiastolic flow reversal in the proximal abdominal aorta
    4. RVol _60 mL/beat
    5. RF _50%
    6. ERO _0.3 cm2
    7. Angiography grade 3+ to 4þ+
19
Q

Reccomendations for AI in

Asymptomatic

Chronic / Severe AI

LVEF < 50%

A

Class 1 indication for surgical AVR

2014 ACC/AHA

20
Q

Diagnosis of chronic Severe AI

A
  1. diagnosis of chronic severe AR r_equires_ evidence of LV dilation
21
Q

Reccomendations for:

asymptomatic

severe AR

Normal LVEF (>50)

LVESD > 50mm

A

AVR is reasonable

Class IIa rec (ACC/AHA 2014 )

22
Q

Reccomendation for

Moderate AI undergoing other cardiac surgery

A

AVR is reasonable

Class IIa Reccomendation (Class IIa ACC/AHA 2014)

23
Q

Reccomendations for

Severe AI

Asymptmatic

LVEF > 50%

LVEDD > 56

A

AVR is reasonable if surgical risk is low

Class IIb

(ACC/ AHA 2014 )

24
Q

Reccomendations for Mitral balloon valvuloplasty

A

level I evidence supports balloon valvuloplasty for:

an asymptomatic patient

moderate mitral valve stenosis,

resting pulmonary artery pressure is greater than 50 mmHg,

left atrial thrombus.

25
Decision pathway if patient has Echocardiographic Severe Asymptomatic aortic stenosis
1. if their LVEF (\<50%) - Class 1A recommendation is for surgery 2. if they are undergoing some other heart surgery -- Class 1 rec is to fix it 3. if they have super severe AS (Vmax \> 4) classII is surgery 4. if they have poor ETT then surgery
26
**_ACC / AHA guidelines for -_** **tricuspid valve** disease in the *absence* of _mitral disease_?
Class IIa - Severe TR in Symptomatic patients Other issues: TV annulus size \> 40mm RV function Pulmonary HTN (\>50mmHg at rest or 60mmHg exercise)
27
when to replace the tricuspid valve in the setting of mitral valve surgery
Class I : Severe TR Class II: Severe TR with pulmonary HTN OR tricuspid annulus \> 40
28
medical therapy for secondary mitral regurgitation
Chronic secondary MR and HF with reduced LVEF should receive GDMT including ACE /ARB BB Aldosterone antagonist

ACC/AHA Guidelines (10 decks)

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