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Cardiology Boards > Valvular > Flashcards

Valvular Flashcards

1
Q

Supravalvular aortic stenosis location

A

Obstruction at aorta

Single discrete narrowing or long tubular hypoplasia

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2
Q

Supravalvular AS exam

A

Loud A2

Thrill in SSN or R carotid

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3
Q

Echo supravalvular AS

A

High velocity jet with narrowed aorta

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4
Q

Subvalvular AS anatomy

A

Discrete ridge or tunnel stenosis

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5
Q

Diagnosis of subvalvular AS

A

High doppler gradient and normal AV

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6
Q

Treatment for subvalvular AS

A

Operate for most patients

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7
Q

Cut-off for aorta surgery with BAV

A
  1. 5 cm
  2. 0 cm if FH, rapid growth, low risk
  3. 5 cm if AVR indicated
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8
Q

AS severe by exam / symptoms but not MG

A

Do hemodynamic Cath or further evaluation

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9
Q

Indications for severe AS surgery

A

Symptoms
EF < 50% with LVH
Very severe AS and surgical risk < 1%

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10
Q

Very severe AS criteria

A

Vel >= 5

MG >= 60

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11
Q

Severe MS S2-OS interval

A

<70

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12
Q

Severe MS MVA

A

<= 1.5

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13
Q

Very severe MS MVA

A

< 1.0

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14
Q

MS symptoms out of proportion to MG ->

A

Exercise hemodynamics

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15
Q

Indication for intervention pliable rheumatic MS

A

Class II-IV symptoms for PMBV

Can consider also is asx, PAP > 60, new-onset AF

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16
Q

Indication for intervention MAC MS

A

Class III-IV symptoms -> MVR

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17
Q

Acute MR treatment

A

Vasodilators
IABP
Surgery

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18
Q

Severe MR jet area

A

> 1/2 LA

19
Q

Severe MR RV

A

> 60

20
Q

Severe MR RF

A

> 50%

21
Q

Severe MR ERO

A

> 0.4

22
Q

Indications for surgery for severe chronic MR

A

Symptoms
EF < 60
ESD > 40
Prophylactic repair without symptoms (low operative mortality, high chance of successful repair)

23
Q

Acute AR treatment

A

Urgent surgery for dissection or acute prosthetic AR
No IABP
Nitroprusside / inotropes
No pressers or beta blockers

24
Q

Severe AR jet

A

> 60% LVOT diameter

25
Q

Severe AR descending thoracic aorta

A

Holodiastolic flow reversal

Velocity > 0.2 m/s

26
Q

Severe AR RV

A

> 60

27
Q

Severe AR RF

A

> 55%

28
Q

Severe AR indications for surgery

A

Symptoms
EF < 50% or abnormal
ESD > 50, EDD > 65

29
Q

Severe TR echo features

A

Dagger shaped TR velocity, low velocity, dense signal

Systolic reversal hepatic veins

30
Q

Treatment left sided mechanical valve thrombosis class III/IV symptoms

A

Surgery or fibrinolysis

31
Q

Treatment left sided mechanical valve thrombosis class I/II symptoms

A

Large clot - surgery, lysis (0.8-1.0)

Small clot - lysis or UFH

32
Q

Treatment right sided mechanical valve thrombosis class III/IV symptoms

A

Lysis

33
Q

Treatment right sided mechanical valve thrombosis class I/II symptoms

A

Large clot - lysis

Small clot - UFH

34
Q

Bioprosthetic valve thrombosis treatment class I-III

A

30 days of VKA then repeat imaging

35
Q

Bioprosthetic valve thrombosis treatment class IV

A

Valve replacement or lysis

36
Q

Infective endocarditis prophylaxis groups

A

Prosthetic valves / material for valve repair
Prior IE
Transplant with valvulopathy
CHD and unprepared cyanotic lesions, cyanotic lesions with palliative shunts or conduits, repair <= 6 months with prosthetic material, repaired lesion with residual defects

37
Q

Procedures that require IE ppx

A

Dental procedures
Incision into active skin / STI
Incision or biopsy in respiratory tract

38
Q

Drugs for IE ppx

A

30-60 min before procedure
Amoxicillan 2 g PO
Clindamycin 600 mg PO, IM or IV

39
Q

Major Duke Criteria

A

Multiple Bcx+
Single coxiella burnetti+
Endocardial involvement - new regurgitation, vegetation, abscess, dehiscence

40
Q

Minor Duke Criteria

A 
Clinical predisposition
Fever without alternative
BCx or serologic evidence of infection not meeting major criteria
Vascular phenomena
Immunologic phenomena
41
Q

Definite IE Duke criteira

A

2 major
1 major + 3 minor
5 minor

42
Q

Possible IE Duke criteria

A

1 major + 1 minor

3 minor

43
Q

Surgical indication for IE

A

Valve dysfunction with HF
Left sided S. aureus or fungal organisms
Heart block, abscess, destructive lesions
Persistent bacteremia or fevers >= 5 days
Recurrent emboli of persistent vegetation despite abs
Mobile veg >= 10 mm
Other surgical indications

44
Q

AV prosthesis stenosis

A

Elevated transvalvular velocity / gradient
AT > 100 ms
EOA < 1
DI < 0.3

Cardiology Boards (11 decks)

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