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cardio RC > Valve disease + aortopathy + pericardial > Flashcards

Valve disease + aortopathy + pericardial Flashcards

1
Q

valve option <50Y

A

mechanical

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2
Q

valve option >65

A

bioprosthetic

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3
Q

valve 50-60 ?

A

individualized decision making

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4
Q

MR, TR medical therapy ? what’s not recommended ?

A
  • treat as HF
  • vasodilator therapy for asymptomatic primary MR and normal LV function
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5
Q

sx of AS

A
  • Angina
  • syncope
  • HF
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6
Q

AS : afterload or preload dependent ? caution wth which meds ?

A
  • afterload dependent
  • VD/afterload reducers ( i.e. ACEI)
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7
Q

Severe AS criteria

A

– Mean Gradient ≥40 mmHg
– Max jet velocity ≥4 m/s
– AVA <1.0 cm2

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8
Q

etiologies of low flow low gradient AS with low EF
-sx

A

LV diastolic dysfunction
LV hypertrophy
LVEF <50%
- angina, hf, syncope

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9
Q

text for low flow low gradient AS with low EF

A

Dobutamine stress echo or calcium score of the valve

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10
Q

low flow low gradient AS with normal EF ( paradoxical low flow low gradient) . why? sx

A

LV wall thickness and small LV chamber with low stroke volume
restrictive diastolic filling
so your EF seems normal

SX: HF, angina, syncope

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11
Q

low flow low gradient AS with normal EF ( paradoxical low flow low gradient) . why paradoxe

A

bcs ef N , but stroke is low but the EF is normal

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12
Q

paradoxical low flow low gradient text ? values

A
  • calcium scoring of the valve
  • > 2000 ( men ) and >1300 *( women)
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13
Q

AS indications for replacement ( Class 1 )

A

Severe, symptomatic AS

Severe, asymptomatic AS with LV dysfunction (LVEF <50%)

Severe, asymptomatic AS undergoing other CV surgery
AHA 2020 Valve

Symptomatic low-flow, low gradient AS with LV dysfunction (LVEF<50%)

Symptomatic low-flow, low gradient AS with LVEF >50% (“paradoxical” low- flow, low-gradient aortic stenosis)
T if AS most likely cause of symptoms

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14
Q

TAVI/TAVR indications

A
  • > 80
    -<10 y
  • 50-65 : could consider
  • intermediate/high/ prohib surgical risk
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15
Q

TAVI contraindicated ?

A

if comorbidiites preclude benefits

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16
Q

what increase in aortic velocity value will prompt you to reasonibly replacement ( class 2a)

A

velocity 0.3 m/s or more per year

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17
Q

if patient is asymptomatic, but have critical AS , what’s critical value velocity ?

A

> 5 m/s

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18
Q

EF% for Class indication in AR?

A

55%

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19
Q

Etiology of MS most often ? associated with what often

A

rheumatic
afib

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20
Q

MS does not like high HR , why?

A

loss of diastolic filling time

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21
Q

MS does not like AF

A

loss of atrial kick

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22
Q

CI to PMBC

A
  1. moderate MR - can make it worse
  2. LA thrombus
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23
Q

in primary MR, what’s the goal of therapy ?

A

-correct MR before LV systolic dysfunction

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24
Q

Class 1 MR

A
  1. Severe, symptomatic primary MR irrespective of EF
  2. Severe, asymptomatic , LV systoluc dysfunction ( EF <60%, LV ESD >40mm)
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25
Q

reasonable class 2 A
- asymptomatic , severe MR, EF >60%, LVESD >40.. what can they get ?

A

mitral valve repair with 95% success and <1% mortality at a comprehensive valve centre

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26
Q

class II a for primary MR with high or prohibitive surgical risk can undergo which procedure if favorable anatomy and life expectancy greater than 1 year

A

transcatheter edge to edge repair

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27
Q

class 1 indication for sx/intervention for secondary MR ?

A

none

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28
Q

what is the treatment of 2nd MR

A
  1. Max GDMT
  2. CRT

before consideration for PMVR aka mitaclip ijn pts wth HFrEF and severe FMR

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29
Q

what’s the class 1 indication for TR surgery ?

A

patient undergoing left sdied valve surgery

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30
Q

trilluminate trial about TR

A

triclip was assocaited wth reduced TR and sx compared with medical therapy alone
- no difference in mortality or HF hospit

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31
Q

AVR INR

A

2-3

32
Q

INR 2.5-3.5 for ?

A

for any MVR or old AVR (ball-in-cage) or AVR with risk factors (RF = AF, prior clot, LV dysfxn, hypercoagulable state)

33
Q

ON-X aortic valve tx and target inr

A

INR 1.5-2
warfarin + low dose ASA

34
Q

bioprostetic valve tx

A

ASA lifelong

35
Q

bioprosthetic valve ( within 3M) + AF

A

VKA

36
Q

TAVI bioprosthetic valve post installation tx initial 3-6M

A
  • DAPT
  • VKA ( low risk bleed)
37
Q

HOCM most common phenotype

A

asymmetric septal hypertrophy

38
Q

AF +HCM tx ?

A

OAC

39
Q

AF + HCM : chads applies ?

A

NOOOO

40
Q

ICD indication
- class 1
- class 2a
- CLass 2b

A
  • VA/ SCD
  • fam hx SCD, LV wall > 30mm, syncope, apical aneurysm, EF <50%
  • LGE on MRI or NSVT on hotelde
41
Q

HOCM is associated w/

A
  • SAM MV –> MR
  • LVOTO ( dynamic )
  • pap msc abN
42
Q

what do you want to avoid HOCM

A

dehydration
Diuretics
VD

43
Q

1st line med tx HOCM
2nd line med
refractory. ?

A
  • BB/CCB
  • cardiomyosin inhib ( disopyramide/mavacamten )
  • septal myotomy/etoh ablation
44
Q

afterload reducing agents to avod in HCM
preload reducing agents to avoid in HCM

A

acei
nitrate, diuertics

45
Q

cardiac amyloidosis presentation

A
  1. restrictive cdmp
  2. hfpef
  3. syncope
  4. atrial arrythmia
  5. bradyarrythmia
  6. AS
46
Q

associated extracardiac manifestation of amyloidosis cardiac

A
  • Autonomic dysfunction
    – Orthostatic hypotension
    – Gastroparesis
    – Sweating abnormalities
    – Neuropathy
    – Carpel tunnel syndrome
    – Renal insufficiency/Nephrotic syndrome
    – Sexual dysfunction
47
Q

mainstay tx of cardiac amyloidosis

A

diuretics

48
Q

cardiac amyloidosis : meds to avoid

A
  • bb/ccb ( reduce CO , esp since restrictive)
    -acei/arb ( worsen dysautonomia, orthostasis )
  • digoxin ( reduces inotropy)
49
Q

1 RF for thoracic aortic dissection

A

htn

50
Q

other rf for thoracic aortic dissection

A
  • vasculitis
  • valve disease ( bicuspid AV)
  • cocaine
  • marfan, ehler danlos
51
Q

best exam for thoracic aortic disease

A

CT

52
Q

thoracic aortic dissection med options

A
  1. BB/CCB
  2. VD ( nitrporusside , ACEI)
53
Q

what do you want to control first in thoracic aortic disease and why

A

HR , not BP
bcs if hr high (or even as a compensatory mechanism) –> ++ sheer stress

54
Q

which thoracic aortic dissect requires urgent surg inter?

A

type a

55
Q

good IV meds for thoraci aortic dissection

A

IV labetalol

56
Q

if <50 , what test first test for thoracic aortopathy / aortic aneurysm

A

MRI

57
Q

serial echo timing in thoracic aorto/aortic aneurysm in loeys-Dietz and Marfan

A

yearly

58
Q

serial echo timing in thoracic aorto/aortic aneurysm in bicuspid AO valve aortopathy or degenerative

A

q1-3y

59
Q

bp meds in marfan
thresholds ?

A

BB/losartan
regardless if pt has htn

60
Q

BP target in thoracic aortopathy/aortic aneurysm

A

target BP <140/90

61
Q

fluoroquinolone in aortopathy may increase what ?

A

aneurysm rupture

62
Q

loeys dietz aorta size for operative management

A

4.5

63
Q

in AAA + asympto, medical therapy proven to reduce risk of rupture ?

A

smoking cessation

64
Q

surveillance recommendation in AAA
- q3y who ?
- q1y who ?
- q6m who

A
  • 3-3.9cm
  • 4-4.9 (M) & 4-4.5(F)
  • > 5 (M), >4.5 women
65
Q

threshold surgery AAA

A
  • men : >5.5 , women >5
  • rate of growth >0.5cm/6 months
66
Q

AAA screening. for who

A

> 65-80 , MEN, US x 1 ever

67
Q

if AAA + atherosclerotic disease present, what can you give ?

A

low dose AS

68
Q

pregnancy vs acute percarditis
- <20 weeks
- > 20 weeks
-bf

ok for colchicine ?

A
  • ASA >nsaid , tylenol, pred
  • tylenol pred
  • avoid ASA

NOOO

69
Q

if nsaid allergy and want to tx acute pericarditis
- pred or colchi ?

A

colchi

70
Q

constriction pericardial signs
- y acting how
- kusmaul ?
- pulsus ?
- other

A

rapid y descent
kussmauk sign
no pulsus paradosis
no

71
Q

temponade pericardial signs
- y acting how
- kusmaul ?
- pulsus ?
- other

A
  • blunted Y descent on jvp
  • no
  • yes
  • beck’s triad
72
Q

what’s beck triad ?

A

hypoTA
distended JVP
muffled heart sounds

73
Q

which pericarditis has
- ventricular interdependence
- no ventricular interdependence

A
  • constriction/tamponade
  • restriction
74
Q

in which disease we see restrictive cmp and ressemble which pathophysio and what’s the difference with that entity

A
  • syst disease (sarcoidosis, amyloidosis)
  • constrictive pericarditis
  • ventricular interdependence
75
Q
A

cardio RC (4 decks)

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