Valvular Disease Flashcards
Mid systolic click is pathognomonic for…
MVP (maneuvers which decrease preload/afterload will make the midsystolic click earlier and the murmur longer and louder)
before percutaneous intervention for MS, why must MR be accurately assessed?
MR that is more than mild is a contraindication to PMBC
after valve surgery, when should TTE be performed?
6-12 weeks post-op to establish a new baseline
What parameters suggest mild AS?
Vmax of 2-3m/s, PG < 20mmHG
how often should you echo:
1. mild AS/AR
2. moderate asymptomatic AS/AR
3. severe asymptomatic AS/AR
mild AS/AR: every 3-5 years
moderate AS/AR: every 1-2 years
severe asymptomatic AS/AR: every 6 months - 1 year (more frequently if LV is progressively dilating)
how often should you echo:
1. progressive MS (MVA > 1.5)
2. asymptomatic severe (MVA 1.0-1.5)
3. asymptomatic severe (MVA < 1.0)
for MVA > 1.5, echo every 3-5 years
for MVA 1-1.5, echo every 1-2 years
for MVA < 1.0, echo every year
how often should you echo:
1. mild MR
2. moderate MR
3. severe asymptomatic MR
mild MR= q 3-5 years
moderate MR= q1-2 years
asx severe MR= q 6 months - 1 year (more frequently than 6 months if LV is dilating)
the mean annual rate of progression in moderate AS for the following:\
1. AVA
2. Vmax
3. PG
- AVA decreases by 0.1cm2 each year
- Vmax increases by 0.3m/s each year
- PG increases by 7mmHg each year
define valvular afib
afib with either at least moderate MS or presence of a mechanical prosthetic valve
Indications for IE ppx prior to dental procedures
- prosthetic cardiac valve or prosthetic material used for valve repair
- previous IE
- congenital HD (unrepairs cyanotic, repaired but prosthesis, repaired but with residual defects)
- heart txp pts with valvulopathy
what exercise RHC findings suggest need for MV intervention?
PCWP at peak of > 25mmHg
mean MV PG of > 15 mmHg
for asymptomatic severe rheumatic MS (stage C), what two additional findings can lead to indication for intervention with PMBC?
new onset afib and PASP > 50mmHg
Inclusion criteria for TEER in COAPT trial for which guidelines recommend TEER (maximum LVESD, maximum PASP, maximum EF)
LVESD </=70
PASP </=70
EF < 50%
and persistent symptoms despite optimal GDMT
when (what aortic sizes) to perform aortic root repair for BAV
- all comers, those with risk factors, those getting AVR
all comers with BAV should get aortic root repair if size > 5.5cm
BAV with additional risk factors (fhx of dissection, >0.5cm in 1 year growth, coart) @ 5.0cm
BAV and getting AVR, repair root at 4.5cm
what Agatson scores in men and women suggest severe AS?
> 1300 in women
2000 in men
