Cardiology- Valves Flashcards
1
Q
Aortic Stenosis Murmur and symptoms
A
Murmur: Cresendo-descrendo in the RUSB Delayed carotid upstroke - pulses parvus et tardus no s2 Mid-systolic click
Symptoms:
- syncope
- dyspnea (heart failure)
- angina
2
Q
Aortic Stenosis - Indications for replacement
A
- symptomatic , severe AS
- Asymptomatic, Severe AS with LVEF <50%
- Asymptomatic Severe AS undergoing CABG
* severe AS Surface area gradient <1.0cm, Transvalvular gradient >40.
3
Q
Indications and CI for TAVR
A
CI:
- bicuspid aortic valve
- Mitral valve disease
- significant AR
Indications
- When surgical risk for valve replacement is high
- STS >8%
- TAVR better than medical mangement for patients unable to undergo surgical valve replacement
4
Q
Monitoring for Aortic Stenosis
A
- Severe: 6-12 months
2. Mild-moderate: 3-5years
5
Q
Indications for valve replacement in AR
A
- symptomatic with any heart function
- Chronic and LVEF <50%
- Chronic and LV diameter >50mm
- Chronic and undergoing other heart surgery
- Acute
6
Q
Murmur and symptoms of AR
A
Murmur:
- diastolic murmur over LLSB
- Holosystolic
- no S2
- widened pulse pressure, bobbing head
- aortic root dilation
Symptoms:
- angina (decreased filling of coronaries during diastole due to early equalization of pressures during diastole)
- heart failure due to inc. left end diastolic filling pressures either acutely or over time
7
Q
Monitoring for Aortic Regurgitation
A
- Severe : 6-12 months
- moderate: 1 year
- mild 3-5 years
8
Q
Bicuspid Aortic Valve Sx and Murmur
A
Murmur:
- mid systolic click at LLSB with associated Aortic stenosis or regurgitant murmur
- Radiation may be to axilla
Sx:
- stenosis/regur sx
- at higher risk for IE- dental health is important
9
Q
Bicuspid monitoring
A
- Echo for monitoring
- Commonly associated with Aortic Aneurysm therefore typically related to that
- If aneurism >5.5cm or growing >0.5cm in 1 year then yearly follow up
- If 1st degree family member has bicuspid AV - screen for aneurysms or valve
10
Q
Bicuspid aortic valve replacement indications
A
- Regurgitant:
- if LVEF <50%
- if symptoms of heart failure - Stenotic:
- severe or symptomatic
11
Q
Mitral Stenosis Murmur and symptoms
A
Murmur:
- opening snap
- Diastolic rumbling murmur
Symptoms:
- Heart failure
- pHTN sx
- a-wave prominent
12
Q
Mitral stenosis repair/replacement indications
A
Balloon Valvuloplasty:
- if NYHA II-IV
- If asx but severe with MVA of <1.0
- if good valve characteristics: pliable leaflets, commisural fusion minimal, minimal calficication
- planned pregnancy
- PASP >50
MV replacement
- NYH III-IV and
- Thrombus or poor valve characteristics or MR
13
Q
Mitral Regurgitation Murmur and symptoms
A
- Radiation to axilla
- holosystolic blowing murmur- systolic
- Left heart failure
14
Q
Mitral Regurg indications for repair/replacement
A
Symptoms
- LVEF 30%-60%
- LV end-systolic diameter ≥40 mm
- Moderate or severe mitral regurgitation at time of other cardiac surgery
- progressive increase in LV size or decrease in LVEF on serial imaging studies
- Pulmonary hypertension (PA systolic pressure ≥50 mm Hg)
- New-onset atrial fibrillation
- prefer repair if favourable anatomy- likley require TEE to determine favourable anatomy
15
Q
Mitral regurgitation Follow up
A
Severe: 6-12months
Mild-moderate: 3-5years
