Pulmonic, Tricuspid, Prosthetic valves Flashcards
Are mild and moderate PR “normal variants?”
Yes
Vmax and peak instantaneous gradient associated with severe PS
Vmax> 4
PIG> 64 mmHg
3 causes of severe PR
Carcinoid
TOF
Endocarditis
In severe PR, where color jet fills RVOT, what will the CW deceleration slope look like?
Steep (may end abruptly)
Most common etiology of Tricuspid Stenosis
Rheumatic
JVP in TS
Giant a- wave
Diminished y descent
What vena contracta is considered severe for all valvular regurge?
> .7cm
What stage is severe, asxs TR (VC>.7cm, hepatic vein systolic flow reversal)?
C
What stage is severe sxs TR (vena contracta>.7cm, hepatic vein systolic reversal)?
D
What do CW jet density and contour look like in severe TR?
Dense
Triangular with early peak
When is TV repair a class I indication for severe TR?
At time of left sided valve Sx
Is pressure half time in severe MS long or short?
Long
Is pressure half time in severe AI long or short?1
Short
Sxs: flushing, diarrhea, wheezing. Dx? What percent of pt’s develop cardiac involvement?
Carcinoid
50%
Test for carcinoid
24h urine 5-HIAA
What valve lesion commonly occurs with carcinoid?
TS
Migraine Rx similar to carcinoid except causes more left sided valve lesions
Ergotamine
What left sidd lesions do radiation and antiphospholipid Ab syndromes usually cause?
AR, MR
What bug requires only a single Cx to be considered a major criteria for endocarditis?
Coxiella burnetti
3 echo findings,besides veg, that count as major criteria for endocarditis
New regurgitation
New partial prosthetic valve dehiscence
Abscess
Typical organisms causing endocarditis
Staph aureus
Strep viridans
Strep G, A, C
enterococcus
Which resistant organisms require early surgery for endocarditis?
Staph aureus
Fungi
What is considered a large vegetation on echo?
> 1cm
Name 4 reasons in endocarditis to do early Sx
Valve dysfxn/LV dysfxn Resistant org (s. aureus, fungi) Heart block/ abscess Persistent infection Increased LVEDP
Abx regimen for endocarditis ppx
Amoxicillin 2g
Cephalosporins or clinda if allergy
Under age 60, what type of prosthetic valve is recommended?
Mechanical
After age 70, what type of prosthetic valve is recommended?
Bio
If you detect regurgitation of a prosthetic valve, how often do you do followup echoes?
q 3-6 mo’s
What are 3 risk factors for thrombosis of prosthetic valve?
AF
previous thromboembolic event
Low EF
All patients with a prosthetic valve (bio or mech) should get what med?
ASA 81
What anticoagulatuon or ASA do you do for a patient with a bio prosthetic valve and 1 risk factor?
Coumadin
What is INR goal for mech AVR and no risk factors?
2-3
What do you do if patient has a thromboembolic event with prosthetic valve when INR was 2.5-3.5?
Inc goal to 3.5-4.5
Which type of prosthetic valve does not require heparin or lovenox bridge for Sx?
Mechanical AVR
Who usually gets patient-prosthesis mismatch?
Older women (LOL)
Which type of prosthetic valve is at greatest risk for thrombosis?
TV
Which prosthetic valves do better with thrombolytics?
Right sided valves
According to prosthetic valve thrombosis guidelines, when is it ok to give fibrinolytics?
Recent onset , NYHA class I-II sxs, small thrombus <.8cm FAILED heparin gtt
What prosthetic valve is at greatest risk of endocarditis?
MVR
When after a prosthetic valve placement, is the greatest risk of endocarditis?
First 6 months
