valves Flashcards
A 72 year old woman presents to cardiology clinic with a six month history of worsening shortness of breath and poor exercise tolerance.
Her function has now deteriorated from a baseline of being able to walk unhindered, now to being extremely short of breath while moving around her house. She has no other significant medical history.
On examination, she is comfortable at rest but becomes easily breathless transferring from the chair to the bed. Auscultation reveals an early diastolic murmur, which is loudest at the lower left sternal edge and is made louder by leaning forward and holding her breath in expiration. There are also bilateral inspiratory crepitations at the bases of her chest, with minimal peripheral oedema.
A trans-thoracic echocardiogram is performed which confirms the diagnosis of aortic regurgitation.
Based on her current condition, which is the most appropriate treatment option to offer her?
Surgical aortic valve replacement
This is the correct answer. This woman has worsening symptoms of heart failure, secondary to aortic regurgitation. Because she is symptomatic, she should be offered intervention. Surgical valve replacement is the most appropriate because she is well enough to tolerate surgery and surgical replacement is more ideal compared to transcatheter implantation (TAVI)
TAVI for cormorbid
A 72 year old man is admitted to hospital following a short episode of unstable angina. He has a history of type 2 diabetes mellitus, hypertension and stable angina.
During his admission, he was noted to have a rumbling mid-diastolic murmur, loudest at the apex on deep expiration and an echocardiogram confirmed a suspected mitral stenosis.
On further questioning, he reports no shortness of breath, and denies orthopnoea, nocturnal dyspnoea and leg swelling. His pulse is regular.
Following this episode of unstable angina, his medication list includes Aspirin, Clopidogrel, Bisoprolol, Ramipril, Atorvastatin and Omeprazole daily, in addition to metformin for his diabetes and sublingual GTN for any further angina.
Which of the following would be most appropriate for management of his mitral stenosis?
No further medications, follow up in 6 months’ time
This is the correct answer. This man has asymptomatic mitral stenosis (MS) with no features of heart failure. MS can remain asymptomatic for a long time, and patients may never progress or require treatment as a result. However if the stenosis does progress, it can lead to irreversible cardiac remodelling and must be treated promptly.
It is therefore important to monitor this category of patients regularly, without subjecting them to unnecessary procedures or interventions
does aortic sclerosis radiate to the carotids
no
A 64 year old patient undergoes a metallic aortic valve replacement due to severe aortic stenosis. She has no other past medical history and took no regular medications pre-operatively.
She remains well three days post operatively and her observations are within normal range with her examining normally.
With which agent should this patient be anti-coagulated long-term?
warfarin
A 65 year old woman is seen in cardiology clinic. She has a past medical history of rheumatic fever during childhood and hypertension. On examination, she has a rumbling mid-diastolic murmur heard best at the apex, in the left lateral position using the bell of the stethoscope.
An echo shows a mitral valve area of 1.9cm2 and her ECG shows sinus rhythm.
What is the most appropriate management option for this patient’s valve disease?
No specific therapy
This is the correct answer. The has the examination findings of the mitral stenosis. Previous rheumatic fever is a significant risk factor for this. The patient is asymptomatic and the mitral valve area is >1.5 cm2, therefore surgical intervention would provide no benefit
when do you use medical therapy in faulty valves
Medical therapy with oral bisoprolol, ramipril and furosemide
This is incorrect. This woman has aortic stenosis, characterised by worsening dyspnoea and an ejection systolic murmur radiating to her carotids. Gold standard therapy for aortic stenosis is either transcatheter aortic valve implantation (TAVI) or open valve replacement, depending on the patient’s fitness.
Medical therapy only as a treatment option should be reserved for patients unsuitable for the above
TAVI over what age
75
causes of a J wave
Other causes include hypercalcaemia or an intra-cranial bleed such as a sub-arachnoid haemorrhage
hypothermia
