Exam 1 - Valvular Heart Disease

Question 1

Name the 4 valves of the heart.

Answer 1

1) Pulmonary valve
2) Tricuspid valve

3) Mitral valve
4) Aortic valve

Question 2

What is the function of heart valves?1

Answer 2

• To direct blood flow in one direction through the heart
• Prevent backward flow of blood, when closed
• Maintain adequate/normal pressure in the heart as well as in the circulation

Question 3

What are the two main types of heart valve abnormalities?

Answer 3

1) Stenosis
- valve fails to open completely

2) Regurgitant (insufficient or leaky)
- valve fails to to close completely

Question 4

What is the name of the valve abnormality in which the valve fails to close completely?

Answer 4

Regurgitant - i.e., Mitral regurgitation

Question 5

What is the name of the valve abnormality in which the valve fails to close completely?

Answer 5

Stenosis - i.e., Aortic stenosis

Question 6

What can occur in congenital valvular abnormalities?

Answer 6

• Wrong size
• Malformed valve
• Missing leaflets

Question 7

What are the most common valves that are affected in congenital valvular abnormalities?

Answer 7

Aortic (bicuspid) and Pulmonic (neonates)

Question 8

Name the four causes of acquired valvular abnormalities.

Answer 8

1) Degenerative (age, MI, cardiomyopathy, aortic aneurysm or dissection, HTN, dyslipidemia, DM, and smoking)
2) Rheumatic fever (valve inflammation)
3) Endocarditis (rare in normal valves)
4) Syphilis, connective tissue disease

Question 9

T/F: Valvular abnormalities can be drug induced.

Answer 9

TRUE

Question 10

What is the MOA of drug induced valvular abnormalities?

Answer 10

Partial to full agonists of 5-hydroxytryptamine 2B receptors (5-HT2BR)
-Activation of 5-HT2BR activates transcription factors in valvular interstitial cells producing proliferation and valvular dysfunction

Question 11

Name the Anorectic drugs that cause drug induced valvular abnormalities.

Answer 11

1) Fenfluramine

2) Dexfenfluramine

Question 12

Name the Dopamine agonists that cause drug induced valvular abnormalities.

Answer 12

1) Peroglide

2) Cabergoline

Question 13

Name the MDMA drug that causes drug induced valvular abnormalities.

Answer 13

1) Ecstasy

Question 14

Name the Ergot alkaloids that cause drug induced valvular abnormalities.

Answer 14

1) Ergotamine

2) Methylergonovine

Question 15

T/F: Pergolide and Cabergoline do not cause drug induced valvular abnormalities.

Answer 15

FALSE - they both do

Question 16

T/F: Ergotamine is the only ergot alkaloid that can cause drug induced valvular abnormalities.

Answer 16

FALSE - Ergotamine and Methylergonovine, both ergot alkaloids can cause drug induced valvular abnormalities

Question 17

In valvular disease, what are the nonspecific symptoms that patients can present with?

Answer 17

• SOB
• Dyspnea
• Fatigue
• Weakness
• Dizziness
• Palpitations

Question 18

What are the signs of valvular disease?

Answer 18

-Murmurs - abnormal heart sounds, abnormal blood movement across valves

Question 19

What are the diagnostic tools available for Valvular Disease?

Answer 19

• Hx/physical
• Echo
• Left/right heart catheterization
• CT, MRI

Diagnostic criteria specific to underlying cause

Question 20

What is the treatment for valvular heart disease?

Answer 20

-NO DRUG THERAPY to treat structural valvular heart disease

• Replacement or repair of valves
• -SAVR/SMVR - surgical aortic/mitral valve replacement; mitral valve repair (open or transcutaneous)
• -TAVR - transcutaneous aortic valve replacement
• -Mechanical valves - metal (rare failure, high rate of thrombus/embolus)

Question 21

T/F: There is no drug therapy for valvular heart disease.

Answer 21

TRUE - once the damage has occurred there is no drug therapy; can replace or repair damaged valves

Question 22

What is the antithrombotic therapy for mechanical valves?

Answer 22

WARFARIN

• Mitral valve = INR target 3.0 (2.5-3.5)
• Aortic valve = INR target 2.5 (2.0-3.0)

DOACs ARE CONTRAINDICATED!!!!!

Question 23

T/F: You can also use DOACs as antithrombotic therapy in valvular heart disease.

Answer 23

FALSE - DOACs are contraindicated

Question 24

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

Answer 24

INR target = 3.0

INR target range = 2.5-3.5

Question 25

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

Answer 25

INR target = 2.5

INR target range = 2.0-3.0

Question 26

In surgical bioprosthetic (tissue) valves, what is the duration and INR target for Warfarin?

Answer 26

INR = 2.5
Duration = 3-6 months if low bleeding risk

Question 27

For surgical bioprosthetic (tissue) valves, what is the length of therapy for DAPT?

Answer 27

3-6 months

Question 28

Why would DAPT therapy be used for surgical bioprosthetic (tissue) valves for antithrombotic therapy?

Answer 28

As an alternative to Warfarin - would be used with low-dose aspirin

Question 29

How long is Aspirin taken for antithrombotic therapy in surgical bioprosthetic (tissue) valves?

Answer 29

LIFELONG

Question 30

In TAVR/TAVI (transcutaneous valve), what is the length of DAPT therapy?

Answer 30

3-6 months

Question 31

In TAVR/TAVI, what is the INR target for Warfarin and duration?

Answer 31

INR target = 2.5
INR target range = 2.0-3.0

Duration = 3 months (low bleeding risk)

Question 32

T/F: Rivaroxaban plus ASA is contraindicated in TAVR/TAVI antithrombotic therapy.

Answer 32

TRUE

Question 33

In moderate-to-severe mitral stenosis, what is the doc?

Answer 33

WARFARIN
INR target = 2.5
INR target range = 2.0-3.0

Question 34

In mechanical valve thrombosis what is treatment?

Answer 34

Low-dose slow-infusion TPA (25 mg/25 h - 6 hours off, may repeat up to 8 times)
–If TPA fails to clear clot, surgical intervention