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Cardiology > Prosthetic Valves > Flashcards

Prosthetic Valves Flashcards

1
Q

If the metallic click is heard in the first heart sound, which valve has been replaced

A

Mitral

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2
Q

If the metallic click is heard in the second heart sound, which valve has been replaced

A

Aortic

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3
Q

What else might you hear on auscultation of a patient with a prosthetic valve

A

Systolic flow murmur

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4
Q

What might be heard with bioprosthetic valves

A

Normal heart sounds

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5
Q

What should the INR be kept at in patients with mechanical heart valves

A

3-4

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6
Q

How long do mechanical heart valves last

A

15 years

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7
Q

What type of biological heart valves are there

A

Xenograft - porcine valve, no warfarin required, lasts 10 years

Homograft - cadaveric valve graft, more durable than xenograft

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8
Q

What is the operative mortality in valve replacement surgery

A

3-5%

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9
Q

In which patients would a bioprosthetic valve be more suitable

A

Any patient in whom anticoagulants are contraindicated

Patients over 70

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10
Q

In which patients would a mechanical valve be recommended

A

Patients less than 60 without contraindications to anticoagulation therapy

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11
Q

What medication should be given to all patients with a prosthetic heart valve

A

75-100mg aspirin

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12
Q

What other medication should be given to patients with a mechanical heart valve

A

Warfarin

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13
Q

When should prophylactic antibiotics be given against infective endocarditis

A

To patients with prosthetic valves before certain types of dental surgery American Heart Association Guidelines

NICE guidelines say no prophylactic antibiotics needed

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14
Q

What organism most commonly causes endocarditis following dental surgery

A

S. viridans

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15
Q

What is the most common causative organism of IE within 2 months of operation for a prosthetic valve

A

Staphylococcus epidermidis

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16
Q

What antibiotics would be used as endocarditis prophylaxis prior to dental surgery

A

Single dose amoxicillin

17
Q

What antibiotic would you give as endocarditis prophylaxis if a patient was allergic to penicillin

A

Cephalexin

18
Q

What is the mechanism of action of warfarin

A

Vitamin K antagonist

19
Q

How is warfarin metabolised

A

Cytochrome P450

20
Q

What drug interactions with p450 enzymes affect warfarin

A

Cytochrome p450 inducers reduce warfarin efficacy Cytochrome p450 inhibitors increase warfarin levels

21
Q

What are some examples of cytochrome p450 inducers

A

NSAIDs and aspirin

Anti-convulsants

Anti-TB e.g. Rifampicin

22
Q

What are some examples of cytochrome p450 inhibitors

A

Antibiotics eg. ciprofloxacin, clarithromycin

Antifungals e.g. fluconazole

23
Q

What are the complications of a valve prosthesis?

A

Complications from surgery- general risks of haemorrhage, infection and anaesthetic risks (mortality of 5%)

Complications from valve itself: Haemolysis, infective endocarditis (may require 2nd replacement), valve dysfunction (leakage, dehiscence), thromboembolism

Complications from anticoagulation: Bleeding

24
Q

What are the complications of prosthetic valves?

A

Valvular:

  • Valve dysfunction e.g. Leakage, dehiscence, obstruction from thrombosis, fibrosis, clogging

Infectious:

  • Endocarditis

Haematological:

  • Thromboembolism
  • Haemolysis
  • Complications of anti coagulation e.g. Bleeding
25
Q

What are the causes of anaemia in a patient with a prosthetic valve?

A

Blood loss secondary to anticoagulation

Haemolysis (commonly aortic prosthesis)

Endocarditis

26
Q

What strain is responsible for late IE after valve replacement

A

Strep viridans

27
Q

What are the different types of mechanical heart valves

A

Starr-Edwards valve - ball and cage

Bjork-Shiley valve - tilting device

St Jude valve - bileaflet

28
Q

What type of prosthetic valve is this

A

Starr-Edwards - ball and cage

29
Q

What type of prosthetic valve is this

A

Bjork-Shiley - tilting device

30
Q

What type of prosthetic valve is this

A

St Jude valve

Cardiology (15 decks)

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