Valve disorders Flashcards
What’s the only effective treatment for aortic stenosis?
aortic valve replacement
What’s your recommendation for type of prosthesis for <60 years for aortic stenosis?
mechanical prosthesis MUST BE PUT ON ANTICOAGULANTS
What’s your recommendation for type of prosthesis for >60 years for aortic stenosis?
porcine or bovine, last 10-15 years and avoid need for anticoagulation!
Is acute aortic insufficiency an emergency?
yes
How do you treat aortic regurgitation?
aortic valve replacement, same as aortic stenosis
afterload management
What prophylaxis must be given in mitral stenosis for high risk patients?
endocarditis
What prophylaxis is essential for all patients to prevent mitral stenosis?
benzathine penicillin
If rhythm is normal sinus in mitral stenosis, tx =
diuretics, BBs, CCbs
If rhythm is afib in mitral stenosis, tx =
ventricular rate control w/ BBs, CCBs, digitalis + anticoagulations
If a patient has mitral stenosis and is unstable, tx =
direct current cardioversion
If there’s a fib, chances are you need
anticoagulation
IF there are signs of pulmonary HTN, intervention is needed!
Treatments for mitral stenosis =
1) percutaneous mitral balloon valvuloplasty
2) valve replacement surgery if 1st isn’t good or high PA pressure
If atrial fibrillation with mitral regurg, tx =
anticoag therapy w/ INR goal 2-3
How do you treat mitral regurg first line?
treat HF, HTN, and reduce afterload with diuretics, BBs, ACE-Is, digitalis
IF a patient has acute ischemic mitral regurg AND endocarditis, tx =
surgery
If a patient has chronic nonischemic severe MR, surgery is recommended if =
symptomatic from CHF
new onset AF
pulmonary HTN
EF<60%
replace valve! mitral clip! TAVI
How do you treat tricuspid stenosis?
diuretics to relieve fluid congestion
What’s the treatment for tricuspid regurgitation?
diuretics for RHF + treatment of pulmonary HTN
What are the indications for treatment for tricuspid regurgitation?
-triscupid regurg
1) clinical decision (improvement)
2) moderate to severe TR or any structural TR
3) RV volume overload
4) RHF
5) repair vs replacement
endocarditis
1) severe TR
2) persistent sepsis
3) recurrent PE
4) excision vs replacement vs repair
How do you treat pulmonary stenosis?
must always monitor!!
diuretics for symptoms + signs of CHF
percutaneous balloon valvuloplasty = initial intervention w/ congenital valvar PS
How do you treat pulmonic regurg?
focus on underlying cause – reduce PA vascular resistance + pulmonary HTN
