CONGENITAL VALVULAR DS, DENTAL PROPHYLAXIS Flashcards
guidelines for proph against endocarditis
- who to medicate?
hx of endocarditis, prosthetic cardiac valve repair, congenital heart ds (unrepair cyanotic ds, completely repaired congenital w prosthetic in first 6 months, repaired cyanotic heart hs w residual effect)
only PROSTHETIC material
dental proph- first line
amoxicillin
dental proph- if allergic to penicillin
cephalexin, clindamycin, azithromycin
reversal agent for:
beta blocker
glucagon
reversal agent for:
heparin
protamine
reversal agent for:
coumadin/warfarin
vit k, fresh frozen plasma
dabigatran (pradaxa)
idarucizumab (pradabind)
digoxin
digoxin immune Fab (digibind)
apixaban (eliquis)
andexanet alfa (andexxa)
tetralogy
- VSD
- concentric RVH
- RV outflow obstruction due to infundibular stenosis
- septal overriding of aorta in 50% of patients
- right sided aortic arch in 25%
repair for Tetralogy
RV outflow patch and VSD closure
- arrhythmias common
septal defects- names
ASD, VSD, PFO (patent foramen ovale)
ASD
- what is it
- symp?
- murmur
failed closure between R and L atrium
- MC asymp till adulthood
- systolic ejection murmur at 2nd LICS
VSD
- what is it
- symp?
- murmur
failed closure between R and L ventricle
- systolic murmur at LLSB
symptoms depend on size
- asymp to failure to thrive
PFO
- what is it
- symp?
- results in
failed closure of foramen ovale
- can be asymp
- embolic CVA known as paradoxical embolism
atrial/PFO L to R causes
RV overload
atrial/PFO R to L causes
cyanosis
emboli are more common in?
PFO vs ASD
repair for Atrial/PFO
percutaneous patch repair
ventricular sd
- how does it repair
- how to determine size
spontaneous closure during growing
VSD side is defined by comparison to aortic root size
25%, 25-75, and >75
consider shunting and obstruction
surgical repair, membranous percutaneous closure
VSD murmur
harsh holosystolic murmur Left 3rd-4th space at LLSB
large VSD have inc what
inc CHF and mortality by 40 y/o
aorta coarctation
systemic secondary HTN presentation, diff in upper vs lower extremities BP
- 20 mmHg gradient
50-80% w a bicuspid aortic valve and cerebral berry aneurysms
turner syndrome associated
coarctation of aorta symptoms, imaging, tx
delayed pulse in femoral compared to brachial
- adv imaging: CT, MRI/MRA
- endovascular stenting preferred
patent ductus arteriosus
what is it, symptoms, murmur?
fetal blood vessel remains open
- abnormal blood flow between aorta and pulm artery
L to R shunting
inc pulm blood flow
potential HF if untreated
L heart has volume overload
murmur- continous machinery like murmur heard at L infraclavicular area
PDA- when does it usually close (functional and permanent)
functional- 24-48 hts after birth
permanent- weeks to months
PDA- tx
NSAIDS, surgical ligation, percutaneous catheter closure
