General Guidelines

Question 1

For stenotic lesions, what 3 key measurements are needed on TTE?

Answer 1

Valve Area
Valve gradient
Maximum velocity

Question 2

What 5 key measurements are needed for measurement of regurgitation lesions in TTE?

Answer 2

Calculation of regurgitant orifice area
Regurgitant volume
Regurgitant fraction
Continuous and pulse wave Doppler recordings
Absence or presence of distal wave reversals

Question 3

What does IAC stand for?

Answer 3

Intersocietal Accreditation Commission

Question 4

For progressive Stage B Aortic Stenosis, how often should imaging be performed?

Answer 4

Mild (Vmax: 2.0-2.9m/s): Every 3-5 years
Moderate (Vmax: 3.0-3.9m/s): Every 1-2 years

Question 5

For patients with Stage C1 aortic stenosis, how often should TTE be done?

Answer 5

If Vmax >/= 4m/s: every 6-12 months

Question 6

For Stage B AI, how often should patients get a TTE?

Answer 6

Mild: every 3-5 years
Moderate: every 1-2 years

Question 7

For Stage C1 AI, how often should patients be evaluated with a TTE?

Answer 7

Every 6-12 months
Or more frequently if dilating LV

Question 8

For Stage B MR, how often should patients be evaluated with a TTE?

Answer 8

If the MV area > 1.5, these patients should be imaged 3-5 years.

Question 9

For Stage C1 MR, how often should patients be evaluated with a TTE?

Answer 9

MV Area 1-1.5cm^2: Every 1-2 years
MV Area <1cm^2: Every 1 year

Question 10

For Stage B MR, how often should patients be evaluated with a TTE?

Answer 10

Mild: Every 3-5 years
Moderate: Every 1-2 years

Question 11

For Stage C1 MR, how often should patients be evaluated with a TTE?

Answer 11

Every 6-12 months
However, if dilating LV, then more frequently

Question 12

What happens if there is a discrepancy between the noninvasive tests and clinical data?

Answer 12

Cardiac catheterization may be required with direct inteacardiac measurements of transvalvular pressure gradients and cardiac output measurements provides valuable clinical information.

Question 13

What are the 3 antibiotics used for secondary prevention of rheumatic fever?

Answer 13

Pen G: 1.2million U IM / 4 weeks
Pen V: 250mg BID PO
Sulfadiazine: 1g PO daily

Question 14

What is the duration of rheumatic fever prophylaxis for patients with Rheumatic fever with carditis and residual heart disease (persistent VHD†)?

Answer 14

10 y or until patient is 40 y of age (whichever is longer)

Question 15

What is the duration of secondary prophylaxis for patients with Rheumatic fever with carditis but no residual heart disease (no valvular disease†)

Answer 15

10 y or until patient is 21 y of age (whichever is longer)

Question 16

What is the duration of prophylaxis for patients with Rheumatic fever without carditis?

Answer 16

5 y or until patient is 21 y of age (whichever is longer)

Question 17

What is one caveat of using the STS Predicted Risk of Mortality?

Answer 17

It can only be used if the institution in which the surgery is being done are 1 standard deviation within the STS average/expected mortality ratio for the procedure in question.

Question 18

What are the seven frailty indices?

Answer 18

Katz Activities of Daily Living independence in:
-feeding,
-bathing,
-dressing,
-transferring,
-toileting, and
-urinary continence) plus
-ambulation (no walking aid or assistance required, or completion of a 5-m walk in <6 s)

Question 19

According to the STS Predicted Risk of Mortality, what is the