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RCE Guidelines Studying > Laflamme- Chapter 4 (Valvular Heart Disease) > Flashcards

Laflamme- Chapter 4 (Valvular Heart Disease) Flashcards

1
Q

What % of patients have BAV? What is most common morphology?

A

1-2%

Fusion of RCC and LCC, followed by RCC and NCC

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2
Q

What congenital abnormality is associated with Supravalvular AS?

A

Williams syndrome

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3
Q

What is physical exam hallmarks on supravalvular stenosis (3)

A
  • BP difference between arms
  • Loud A2
  • Murmur to right carotid
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4
Q

Echo surveillance for Mild, mod, severe AS

A
  • Severe: 6-12months
  • Mod: 1-2 years
  • Mild: 3-5 years
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5
Q

Progression of AS based on AVA and MG?

A
  • AVA: 0.1cm / year

- MG: 7mmhg / year

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6
Q

Definition of LFLG AS?

A
  • AVA < 1
  • MG < 40mmhg
  • SVI < 35
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7
Q

What are the Class 1 indications for AVR? Class IIa?

A

Class 1

  • Severe symptomatic AS
  • Going for other OR with severe
  • Severe with LVEF < 50%

Class IIa

  • Very severe 5m/s
  • BNP 5x normal
  • Moderate other OR (IIb)
  • EST SBP drop > 10mmhg
  • > 0.3/year progression
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8
Q

What are 3 anatomic contraindications to TAVR?

A
  • Aortic annulus diameter <18mm and >29mm
  • Coronary ostia < 10-11mm from aortic annulus
  • Femoral vascular access issues (<6 mm space, to accommodate a 7mm catheter)
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9
Q

What is the risk of PPM with TAVI?

A
  • 5-10% Sapien

- 20% corevalve

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10
Q

What is 30 day mortality post TAVI?

A

-3-5%

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11
Q

What are 8 echo features of severe AR?

A
  • VC > 6cm
  • ERO > 0.3cm
  • RF > 50%
  • Rvol > 60cc
  • PHT < 200 msec
  • > 65% LVOT in PLAX
  • Flow reversal TA
  • LVEDD 65, LVESD 50
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12
Q

Indications for AVR in AR?

A
  • Symptomatic severe
  • LVEF < 55%
  • LVEDD > 65, LVESD > 50
  • Severe and other OR
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13
Q

What are 5 causes of LV inflow obstruction?

A
  • MS
  • PV stenosis
  • LA tumor
  • MV vegetation
  • LA thrombus
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14
Q

How can MS cause hoarse voice?

A

-Recurrent laryngeal nerve compression by dilated LA

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15
Q

What is rate of MS progression per year?

A

0.09 cm/year

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16
Q

What defines successful balloon valvuloplasty in MS?

A
  • MVA > 1.5m LA pressure < 18mmhg
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17
Q

3 indications for MVR/Valvuloplasty in Mitral Stenosis?

A
  • Symptoms with mod-severe MS
  • MVA < 1
  • De novo AF
  • Other surgery planned
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18
Q

9 features of severe MR on echo?

A
  • VC 0.7
  • RF 50%
  • Rvol 60cc
  • ERO 0.4
  • E wave triangular
  • E wave > 1.2c,
  • Systolic flow reversal
  • LA and LV dilation
  • Jet > 10 cm2, >40% LA, Coanda effect
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19
Q

What are 5 features that promote favorable chance to Mitral valve repair?

A
  • MVP, posterior leaflet
  • DMR
  • Annular Dilation
  • Papillary muscle dysfunction
  • ruptured chordae
  • Leaflet perforation
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20
Q

What anatomic features are favorable for mitra clip?

A
  • Malcoaptation of A2-P2
  • Depth of Coaptation < 11mm
  • Vertical length of coaptation > 2mm
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21
Q

Name 5 systemic diseases that are associated with MVP?

A
  • Marfans
  • Ehlers Danlos
  • Osteogenesis Imperfecta
  • Holt-Oram syndrom
  • Ebsteins
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22
Q

What are 6 causes of TS?

A
  • Carcinoid
  • Rheumatic Valve disease
  • Radiation
  • PPM lead
  • Endocarditis
  • RA tumor
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23
Q

What are 6 echo findings of Severe TR?

A
  • Jet area > 10cm2
  • VC > 7mm
  • PISA > 9mm
  • Tricuspid E > 1
  • Dense doppler envelope with triangular peak
  • holosystolic flow reversal in hepatic vein
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24
Q

What is definition of severe PS?

A

-Peak gradient > 64 mmhg

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25
Q

What congenital syndrome is associated with PS?

A

-Noonan Syndrome

26
Q

What is the echo feature for severe PR?

A

-Dense envelope, marked deceleration, early end of diastolic flow

27
Q

What is Graham Steel Murmur?

A
  • Decrescendo high pitched diastolic murmur in the presence of dilatation of the pulmonary annulus secondary to PHTn
  • Accentuated P2, starts after A2
28
Q

6 reasons to go for tissue valve?

A
  • Bleeding risk
  • Difficult anticoagulation
  • > 70 years
  • Small LVOT
  • Woman of childbearing potential
  • Patient preference
29
Q

What is TE risk for mechanical valves in Mitral and Aortic valves?

A
  • Mitral: 2-3/100 patient years

- Aortic: 1-2/100 patient years

30
Q

What is % of structural deterioration at 10 years?

A
  • 30% at 10 years (only 10% at ten years in patients greater than 65)
31
Q

What are three indications for urgent surgery in Prosthetic thrombus?

A
  • Left heart prosthesis (class 1)
  • NYHA III/V (class 1)
  • Mobile/Large thrombus ( > 0.8 cm2)
32
Q

What are 4 indications for UFH +/- thrombolysis in patients with Prosthetic valve thrombus?

A
  • Thrombosis < 14 days
  • NYHA 1 or 2
  • Thrombus < 0.8cm2
  • Right heart prosthesis
33
Q

What patients with mechanical valves should get INR 2-3 with aspirin?

A
  • MVR

- AVR with AF, LV dysfunction, TE history, Hypercoagulable state

34
Q

How to reverse life threatening bleed on excessive anticoagulation?

A
  • Prothrombin complex/FPP

- Vitamin k

35
Q

Echo follow up for tissue prosthesis?

A
  • 2-4 weeks after DC

- 10 years post, annual after

36
Q

Echo follow up for mechanical valve?

A

-Baseline 2-4 weeks post OR, never again in absence of symptoms

37
Q

What are top 3 microbes for native valve IE?

A
  • Staph Aureus
  • CONS
  • Step viridans
38
Q

Name all of the HACEK organisms

A

Hemophilus

Actinobacillus

Cardiobacterium

Eikenella

Kingella

39
Q

What are the 4 most common microbes for early (<12 months) post valve surgery?

A
  • SA
  • CONS
  • GNB
  • Fungi (Candida)
40
Q

How does last PVE IE (>12 months) micro differ from early?

A

Same as native (SA, CONS, Strep) , no Fungal/GNB

41
Q

2 major criteria for DUKE score?

A
  • Positive blood culture: Causative agent, sustained: 3/3 or majority of 4 when taken an hour apart OR 2 positive q12h apart
  • Endocardial: either Positive echo for vegetation OR de novo valvular regurgitation
42
Q

What are 5 minor criteria for DUKE score?

A
  • Predisposition
  • Fever
  • Vascular
  • Immunologic
  • Micro evidence not meeting
  • Major criteria
43
Q

Abx for IE for Strep?

A

CTX x 4 week (Vanco x 4 week)

44
Q

ABx for Strep for PVE?

A

-Add Gentamicin for first 2 weeks

45
Q

Abx for IE for MSSA? PVE?

A
  • Cloxacillin x 6 weeks

- Clox + Rifampin + Gentamicin

46
Q

Abx for MRSA? PVE?

A
  • Vanco x 6 weeks

- Vanco + Rifampin + Gentamicin

47
Q

Abx for Enterococcus?

A

-Amp + Gentamicin x 6weeks

48
Q

Abx for HACEK?

A

CTX x 4-6 weeks

49
Q

4 population for IE prophylaxis?

A
  • PV
  • Hx IE
  • Transplant with regurgitant or structurally abnormal valve
  • CHD: Unrepaired cyanotic heart disease, complete repair with prosthetic material < 6 months, repair with residual defect close to prosthesis
50
Q

What is antibiotics for IE prophylaxis?

A
  • Amoxicillin 2g PO
  • Cephalexin 2g PO
  • Azithromycin 500mg
  • Clinda 600mg
  • Ancef 1g IV
51
Q

What are 6 indications for surgery for bacterial endocarditis?

A

Symptomatic HF

Highly resistant organism

Complicated (by block or abscess)

Persistent infection (> 5-7 days despite appropriate antibiotics)

Recurrent emboli

Vegetation > 10mm

52
Q

What are the three micro for CIEDs?

A

-CONS > MSSA > MRSA

53
Q

Management of Superficial skin infection?

A

-Oral abx for staph for 7-10 days

54
Q

Management for pocket infection/skin erosion?

A

-Complete removal of the system and antibiotics

55
Q

Management of system infection? Lead endocarditis

A

-Remove system, Abx for 2-6 weeks -> reimplant

56
Q

What is optimal timing for reimplantment of the device after CIED: + blood culture, Valve endocarditis

A
  • +BCx: 72h

- Endocarditis: 14 days

57
Q

What are the 5 major JONES criteria?

A
  • Carditis and valvulitis
  • Migratory arthritis
  • Sydenhams chorea
  • Erythema marginatum
  • Subcutaneous nodules
58
Q

When do you need to start Abx for GAS to prevent Rheumatic fever?

A
  • < 10 days

Penicillin V 500mg PO BID x 10 days

59
Q

How do you give secondary prevention post rheumatic fever? (Penicillin 200mg PO BId, or Sulfasiazine 1g PO daily)

A
  • No carditis: > 5 years since episode until age 21
  • Carditis but no sequelae: >10 years since episode until age 21
  • Valvular disease: > 10 years since last episode until 40 years.
60
Q

What is the mortality per year for symptomatic AR in the absence of intervention?

A

-10% / year

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