treatmnet

Question 1

what is the managmnet of aortic valve stenosis stenosis ?

Answer 1

acute decomepnsated heart failure
loop diuretics with caution because patinets are very suscopetible to hyotension
consider vasodilators such as nitroprsside

in cardiogenic shock
iv fluid managemnet
dobutamine and dopamine
consider bridging device - intraaortic balloon pump
percutenaous balloon valvulopasty - but in effective in adults

atrial fib - managmnet

chronic cases
repair or replacemnet - replacemnet preferred
there is mechanical valve replacement lasts longer
there is prosthetic valve replacemnet
transcather aortic valve repacemnet - highly sympotmatic and high risk to surgery
hemodynimaclly snsatble - acute decemponesation hf
cardiogenic hsock
electrical instablity

Question 2

what is the management of aortic regurgitation ?

Answer 2

NO hr slowing drugs such as beta blockers should be administered or they should be removed
physical exercise without excessive straining reduces regurgitation

left sided heart failure
loop diuretics , thiazides ace

we can give peripheral arterial and venous vasodilators

surgical - to those who are symptomatic with acute AR because medications do not help
those who have worsening congestive heart failure or ejection fraction below 50
and those who are symptomatic and refactor to medical treatmnet

mostly there s aortic valve replacement with anticoagulation therapy

Question 3

what is the management of mitral valve stenosis ?

Answer 3

heart failure : only diuretics can be given!
there is also calcium channel blockers and beta blockers may be given

if still symptomatic or if mitral valve stenosis is less than 1.5cm2
for first line syptomatic - mitral valve ballooon comisurotomy

however criteria need to be fulfilled :
no or litter mitral valve regurgitation 
the valves have good moprhology and not deformed
no calcificatons 
no left atrial thrombus 

second line - open commisurotomy an mitral valve replacement by porsthetc ror mechnical

Question 4

what is the management of mitral valve regurgitation ?

Answer 4

in acute decompensated hf - loop diuretics in combination with spironolactone USED WITH CAUTION
in severely decompensated decrease the afterload - nitroprusside

in cardiogenic shock
ionotropes and vasopressures such as dobutamine
consider an intraortic balloon pump which is a bridging device

if acute - secondary MR suspected = treate the underlying cause such as ischemia = revascularisation therapy

consider left ventricle assisteng device deterioirating depsore pharmacological therapy

surgery

chronic cases

heart failure - diuretics
acei
beta blockers

signs of pulmonary andretrograde congestion
diuretucs - loop with spirornolcatne
decrease the afterload
decrease he preload

surgery for symptomatic patients and lvef is low
valve repair preferred over valve replacemnet

Transcatheter mitral valve procedures,- clip device, can be considered in patients who are considered to be unsuitable for surgical repair and severely symptomatic.

Once LVEF is < 30%, surgery is generally not recommended

LVAD and cardiac transplant: consider for patients whose heart failure is driven by severe LV remodeling.