Cardiovascular Vivas

Question 1

What is used for biological (bioprosthetic) valve replacement?

Answer 1

Bovine or porcine

Question 2

What is the most common mechanical valve used?

Answer 2

Bileaflet valve
(ball and cage now rarely used)

Question 3

What is the major disadvantage of biological valves?

Answer 3

Structural deterioration + calcification
May require future replacement, posing additional risks

Question 4

What is the major advantage of biological valves?

Answer 4

Lower risk thrombogenesis
Long term anticoagulation not usually needed
Warfarin maybe given for first 3 months depending on patient factors

Question 5

Describe the use of aspirin in biological valves

Answer 5

Low dose aspirin given longterm

Question 6

In which patient group are biological valves preferred?

Answer 6

> 65s for aortic valves
70s for mitral valves

Question 7

What is the main advantage of mechanical valves?

Answer 7

Greater longevity +
low failure rate

Question 8

What is the major disadvantage of mechanical valves?

Answer 8

Increased risk of thrombosis meaning long term anticoagulation is needed

Question 9

What is the preferred form of anticoagulation for patients with mechanical heart valves?

Answer 9

Warfarin

Question 10

What is the target INR for aortic and mitral mechanical valves?

Answer 10

Aortic: 3.0
Mitral: 3.5

Question 11

Describe the use of aspirin in mechanical valves

Answer 11

Only given if additional indication e.g. IHD

Question 12

What are the guideline regarding prophylaxis of endocarditis in patients with valve replacements?

Answer 12

No abx recommended for common procedures

Question 13

3 features of typical Anginal chest pain

Answer 13

1. Constricting discomfort in front of chest, neck, shoulders, jaw or arms
2. Precipitated by physical exertion
3. Relieved by rest or GTN in ~5 mins

Question 14

4 Midline sternotomy causes

Answer 14

Open aortic/ mitral valve surgery
Coronary artery bypass grafting (CABG)
Cardiac transplant
Correction of congenital cardiac defects

Question 15

4 symptoms of aortic stenosis

Answer 15

Fatigue
Dyspnoea
Exertional syncope
Exertional angina

Question 16

Mx of AS

Answer 16

Asymptomatic: monitor
Symptomatic: valve replacement
Asymptomatic but valvular gradient > 40 mmHg + features such as LV systolic dysfunction, consider surgery

Question 17

First line Mx of symptomatic AS

Answer 17

Open AV replacement
High operative risk: Transcatheteric AV implantation (TAVI= repair without need for removal)

Question 18

3 aetiologies of mitral regurgitation

Answer 18

Ischaemic: papillary muscle rupture post MI
Non-ischaemic: IE, RHD
Iatrogenic: rare, due to trauma of leaflets/ chords e.g. in TAVI

Question 19

Acute MR symptoms

Answer 19

Sudden + marked increase in congestive HF Sx, with weakness, fatigue, dyspnoea, respiratory failure + shock.
a/w peripheral vasoconstriction, pallor, + diaphoresis.

Question 20

2 Chronic MR symptoms

Answer 20

Exertional dyspnoea
Fatigue

Question 21

4 causes of chronic AR due to valve disease

Answer 21

Rheumatic fever: most common cause in developing world
Calcific valve disease
CTDs e.g. RhA/ SLE
Bicuspid aortic valve (affects valves + aortic root)

Question 22

5 causes of chronic AR due to aortic root disease

Answer 22

Bicuspid aortic valve (affects both valves + aortic root)
Spondylarthropathies (e.g. Ank spond)
HTN
Syphilis
Marfan’s, Ehler-Danlos syndrome

Question 23

2 causes of acute AR

Answer 23

Infective endocarditis
Aortic dissection

Question 24

Symptoms of AR

Answer 24

Asymptomatic
Exertional dyspnoea
Angina
HF Sx: Orthopnoea, PND, pulmonary oedema

Question 25

Mx of AR

Answer 25

Medical Mx of any associated HF
Surgery:
Symptomatic patients with severe AR
Asymptomatic patients with severe AR + LV systolic dysfunction

Question 26

Investigation of choice for aortic dissection

Answer 26

CT angiography of the chest, abdomen + pelvis
False lumen
Suitable for stable patients + for planning surgery

Question 27

Investigation for aortic dissection in unstable patients

Answer 27

Transoesophageal echo

Question 28

What causes rheumatic fever?

Answer 28

Immunological reaction to a recent (2-4w ago) Streptococcus pyogenes infection.