Aortic Stenosis Flashcards

1
Q

What is range velocity for mild to critical stenosis for AS?

A

mild < 3 m/sec
moderate 3–4
severe 4 - 4.5
critical > 4.5

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2
Q

What is range aortic valve area for normal to critical stenosis for AS?

A
normal 2.5 - 4.0 cm2
mild 1.5 - 2.0 
moderate 1.0 - 1.5 
severe 0.7 - 1.0 
critical < 0.7
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3
Q

What is range mild transvascular gradient for mild to critical stenosis for AS?

A

mild < 25 mmHg
moderate 25 - 40
severe 40 - 50
critical > 50

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4
Q

What patient’s require bacterial endocarditis PPX?

A

1) prosthetic cardiac valve or prosthetic material used for valve repair
2) prior infectious endocarditis
3) unrepaired cyanotic congenital heart disease
4) 6mo post-op period following a repaired congenital heart defect using prosthetic material or a device
5) repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or device
6) cardiac transplant recipients who develop cardiac valvopathy

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5
Q

Heparin 5000SQH: time to hold before epidural, when to restart after epidural

A

wait 4-6hrs for placement

can restart immediately, takes 2hrs for drug effect

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6
Q

Heparin gtt: time to hold before epidural, when to restart after epidural

A

wait 2-4hrs after stopping

delay starting for 1hr after placement

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7
Q

LMWH: time to hold before epidural, when to restart after epidural

A

low dose lovenox 40mg
delay for 12hrs following low dose

high dose lovenox 1mg/kg BID
delay 24hrs for high dose

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8
Q

Abciximab: time to hold before epidural, when to restart after epidural

A

delay for 1-2 days

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9
Q

Apixaban: time to hold before epidural, when to restart after epidural

A

delay for 72hrs (longer with renal impairment)

wait to restart until 6hrs after

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10
Q

How much does atrial kick contribute to cardiac output in normal patient? Pt with aortic stensois?

A

normal 20%

AS 30 - 40% due to decreased compliance of the left ventricle

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11
Q

What causes concentric ventricular hypertrophy?

A

results from pressure overload
sarcomeres are added in paralleled (thickening rather than lengthening)
ventricular volume is not increased

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12
Q

What causes eccentric ventricular hypertrophy?

A

results from volume overload
sarcomeres are added in series (lengthening rather than thickening)
ventricular volume is increased

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13
Q

how long do you postpone elective surgery for angioplasty, BMS, DES?

A

angioplasty - 14 days
BMS - 1 month
DES - 6 months (can do 3mo if risk of delaying surgery more than risk of stent thrombosis). Continue plavix for 1 year after.

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