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Cardiology > Valve Disease > Flashcards

Valve Disease Flashcards

0
Q

Bicuspid incidence

A

1-2% general population
Majority never develop stenosis
Associated with coarctation

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1
Q

Bicuspid aortic stenosis

A

Look for AI and aortic dissection

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2
Q

Aortic stenosis

A

May be atherosclerotic
Severe stenosis late peaking with obscure s2
Pulses parvus tardus

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3
Q

Valve area

Cardiac out put/ heart rate x SEP x 44.3x square root of the gradient

A

Hakki

Cardiac out put/ square root of the gradient

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4
Q

Aortic stenosis

A

Mild velocity 1.5

Severe velocity >4m/sec gradient >40 valve area <1.0

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5
Q

Severe a symptomatic AS

A

Stress test is reasonable

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6
Q 
AS follow up 
Change in symptoms 
Asymptomatic
Yearly for severe AS
Every 2 years got moderate AS
Every 5 for mild
A

Expect
Jet velocity increase 0.3 m/sec
Gradient increSe 7 mmhg/ year
Valve area decrease 0.1 cm per year

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7
Q

AS symptoms and survival

A

Angina 5 years
Syncope 3 years
Failure 2 years

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8
Q

Low flow low gradient

A

10% cases
Dibutamine echo
Low flow Gorlin formula is wrong
Pseudo stenosis due to after load mismatch

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9
Q

Treatment of AS

A

Statin no benifit by saltire trial

Acei poss effect on inflammation

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10
Q

AVR

A

2-4% mortality in low risk

15-20% in high risk

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11
Q

TAVR indications

A

Severe AS
STS greater than 8%
Inoperable high risk
Life expectancy greater than 1 year

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12
Q

Bicuspid and aortic root

A

Replace aorta greater than 5.5 cm
Greater than 5 for rapid progression
Aorta greater than 4.5 with severe AS

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13
Q

AI severity

A

Vena contracts 0.6
Pressure half time mild >450 severe central jet width 65%,flow reversal > 0.6m/sec, Regurgitant volume >60ml, Regurgitant fraction > 55% EROA 0.3
Pressure half time 200 vena contracts >0.6 cm2

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14
Q

Acute AI

A

Tachycardia
Pulm edema
Short murmur
Diastolic MR

No IABP use nipride

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15
Q

AI presentation

A

Dyspnea

Angina due to decreased reserve

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16
Q

AI low EF

A

Need AVR

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17
Q

AI symptoms

A

Symptoms 25% a year

After symptoms death 10% a year

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18
Q

Chronic AI

A

Nifedipine and acei class 1

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19
Q

AI operative mortality

A

EF >50% 3.7%
35%. 6.7%
<35% 14%

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20
Q

AI indication for surgery

A

Symptoms
LV dysfunction 50
EDD>70(2b)
LVESD>55

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21
Q

MS

A

Evaluate for afib

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22
Q

MS severity

A

Mild gradient 1.5

Severe gradient >10 PAP >50 area <1.0

23
Q

MS

A

OS

Loud S1

24
Q

Survival of MS

A

No symptoms 10 year survival 80-100%
Limiting symptoms 10 year 0-15%
Pulm HTN < 3 years

25
Q

MR severe

A 
Jet area >0.5
Regurgitant volume >60
Regurgitant fraction >55%
Vena contracts >0.7 cm
ERO >0.4
Normal LA the MR is not severe
26
Q

MR types

A

Type 1 dilated root
Type 2 prolapse
Type 3 pap dysfunction
3b ischemic

27
Q

Increase MR

A

DecreAse survival
Increase CV events
LV gram is still gold standard

28
Q

Moderate MR

A

Annual echo

29
Q

Indication for mitral surgery

A

EF >30% ESD 55 if chordal preservation likely, medical therapy if chordate can’t be preserved
Severe MR EF < 60% or ESD >40 mm
New onset afib or pulm HTN
Do early before symptoms worsen

30
Q

MR

A

Repair if possible

31
Q

Pulm stenosis

A 
Isolated 
Tetralogy
Rubella
Carcinoid
Gradient >4m/sec
Treatment valvuloplasty
32
Q

Pulm regurgitation

A 
Carcinoid
Tetralogy
Endocarditis 
RV overload
Bio prosthetic
33
Q

TRicuspid stenosis

A 
Rheumatic
Carcinoid
Congenital
Fabry
Drugs ergot
Valve area 1 cm2 balloon or bio prosthetic
34
Q

TR

A 
Pulm HTN 
Cardiomyopathy 
Left sided valve disease
Rheumatic
Ebstein
Radiation
35
Q

Surgery severe TR

A

Severe TR in peopke undergoing left sided valve surgery
Less than severe TR with left sided valve surgery if there is pulm HTN
Severe TR with symptoms
Primary TR with RV failure

36
Q

MS and AI

A

Pressure half time of MS will be long and pressure half time of AI will be short

37
Q

Carcinoid

A 
Primary GI
Cardiac involvement 50%
Check 24 hour urine 5-HIAA
Octreo scan
Ergot
Diet drugs
38
Q

Radiation effects

A

10-15 years after radiation
Coronaries valves and pericardium
Concomitant chemo
MR and AI

39
Q

Antiphospholipid antibody

A

Superficial thrombosis
Non bacterial endo
Regurgitation MR AI

40
Q

Endocarditis

A

Blood cultures single for coxiella
Evidence if vegetation
Echo evidence

41
Q

Endocarditis

A

DX 2major
1 major 3 minor
5 minor

42
Q

Prophylaxis

A 
Prosthetic valves
Prior endo
Unrepaired cyanotic congenital
Repaired with residual
Transplant with Regurgitant lesions
43
Q

Bio prosthetic after 70

A 
Routine yearly echo class 2b
Regurgitation detected every 3/6 mos
44
Q

Mechanical valves and Coumadin

A

Stroke untreated 4-8% a year
Treated 1-2% year
Bio prosthesis 1-2% a year

45
Q

Anticoag guide lines

A

Afib
Previous CVA
Hypercoagulable state
EF <30%

46
Q

Asa 75 all mechanical and bio

A

INR 2-3 mechanical AVR and 3 MIs for bio

INR 2.5-3.5 for the rest

47
Q

Short term interruption of Coumadin

A 
Bi leaflet AVR no bridge 
Bridge all the rest with UFH 
Lmwh is ok now
FFP urgent cases
No vit K
48
Q

Bio prosthetic

A

20-30% dysfunction in 10 yrs
50% by 15 years
Increase in young pregnancy and RF
Look for patient valve mismatch

49
Q

Valve thrombosis

2% per year

A 
Thrombolysis effective 70-90%
More on the right sided
Mortality 4-12 % with lysis 
Surgery for large clot class 3-4
Small clot class 1-2 consider lysis
50
Q

Endocarditis

A

Mitral more common
0.5% even with antibiotics
Stable endo no surgery needed
Hemolysis may need to be replaced

51
Q

AS surgery

A

Symptomatic
EF less than 50% no symptoms
Worsening gradient
Abnormal stress test

52
Q

MS

A

Symptomatic survivsl 50%

Valvuloplasties symptomatic or asymptomatic with moderate to severe disease with pulm HTN

53
Q

Tricuspid stenosis

A

Gradient 7mm hg area 1 cm2

54
Q

TR severity

A

Jet width 0.7
Pisa 0.9
Vena contracta >0.7
Central jet >10cm2

Cardiology (18 decks)

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