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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
Q

Decision pathway if patient has

Echocardiographic Severe

Asymptomatic aortic stenosis

A
  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
Q

ACC / AHA guidelines for -

tricuspid valve disease in the absence of mitral disease?

A

Class IIa - Severe TR in Symptomatic patients

Other issues:

TV annulus size > 40mm

RV function

Pulmonary HTN (>50mmHg at rest or 60mmHg exercise)

27
Q

when to replace the tricuspid valve in the setting of mitral valve surgery

A

Class I : Severe TR

Class II: Severe TR with pulmonary HTN OR tricuspid annulus > 40

28
Q

medical therapy for secondary mitral regurgitation

A

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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