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ACCSAP > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

most common mechanism of TR.
leaflet restriction and eccentric regurgitation.
redundant tissue

A

annular dilatation.
leaflet restriction and eccentric regurgitation.
myxomatous degeneration

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2
Q

Endocarditis early surgery for:

A

HF
Persistent bacteremia or fevers lasting >5 days after onset of appropriate antimicrobial therapy;
Heart block, annular or aortic abscess, or destructive penetrating lesions;
Highly resistant organisms (e.g., Staphylococcus aureus, fungal, Pseudomonas aeruginosa, Brucella, enterococci, and other gram-positive cocci)
Recurrent emboli.

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3
Q

Severe AI.
Intervene (SAVR only) if

A

vena contracta >0.6 cm, RF >50%, and RVol >60 mL.
LVESD >50 mm/ LVESDi >25/ LVEF <55% or symptomatic

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4
Q

Mechanical mitral valve AC

A

Warfarin only with goal INR of 3. Can add aspirin if atrial fibrillation, previous thromboembolism, LV dysfunction, hypercoagulable state

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5
Q

greatest likelihood of successful mitral valve repair

A

localized prolapse of P2 and A2

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6
Q

low likelihood of successful mitral valve repair

A

prolapse involving three or more scallops, extensive annular/leaflet calcification, destructive lesions of the leaflets, and mitral annulus diameters >50 mm

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7
Q

MVP MR assessment

A

CMR

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8
Q

Acute hemorrhagic stroke

A

no anticoagulation at all

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9
Q

Marfan characteristics

A

mitral valve prolapse, pectus carinatum, pneumothorax, scoliosis, skin striae, severe myopia, retrognathia, malar hypoplasia, enophthalmos, aortic disease (main cause of M&M).
Decreased preload (sitting, standing)-> earlier click, louder. Increased afterload (squatting)-> later click, decreased murmur.
Louder on valsalva.
Other MR murmurs do the opposite.

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10
Q

Most common cause of aortic valve pathology in elderly

A

Degenerative (sclerocalcific) disease

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11
Q

PDA echo

A

diastolic flow reversal in the aorta

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12
Q

Vasodilators for AI

A

Asymptomatic + SBP > 140

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13
Q

Severe MR.
Intervene if.
Chronic primary MR meds

A

EROA >0.4, RF >50%, Rvol > 60 ml
Symptomatic/ LVEF ≤60% or LVESD ≥40 mm/ pulmonary hypertension/ afib.
None, can treat htn.

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14
Q

Provoke symptoms in valvular disease with

A

exercise, not dobutamine

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15
Q

Impact of TAVR paravalvular leak.
TAVR vs SAVR advantages

A

increased mortality.
lower transvalvular gradients, larger effective orifice areas, and less patient–prosthetic mismatch

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16
Q

diastolic decrescendo murmur along the LSB, systolic murmur at the right USB and an Austin Flint murmur (apical diastolic murmur due to the AR jet restricting opening of the anterior mitral leaflet).

A

AI

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17
Q

Severe primary MR treatment

A

surgical repair. If high or prohibitive surgical risk and suitable anatomy for the procedure-> mitraclip.

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18
Q

Severe MS
Incongruent symptoms vs echo

A

MVA < 1.5
Exercise echo/RHC: PA wedge pressure >25 mm Hg or mean MV gradient >15 mm Hg

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19
Q

prolonged AT (>100 msec)

A

intrinsic abnormality of valve. Degeneration is chronic, thrombus is acute

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20
Q

severe PPM aortic.

severe PPM mitral

A

indexed EOA <0.65 cm2/m2. associated with a lack of regression of LVH following valve replacement.
<.9,

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21
Q

capillary nail bed pulsations (known as Quincke’s sign), retinal arteriolar pulsations (Becker’s sign), water hammer pulses (Corrigan’s pulse), head bobbing (De Musset’s sign), and uvula pulsations (Muller’s sign).

A

AI

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22
Q

Duroziez sign elicited by

A

compressing the femoral artery with the diaphragm of the stethoscope, If severe aortic regurgitation is present, a diastolic murmur from retrograde flow will then be heard.

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23
Q

Surgical Bioprothestic mitral valve med

A

3-6 mos: warfarin, INR goal of 2.5
lifelong aspirin

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24
Q

TAVR AC

A

DAPT for 6 months

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25
Q

TMVR

A

high or prohibitive surgical risk and/or secondary MR

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26
Q

No benefit of mitraclip

A

left ventricular end-diastolic dimension (LVEDD) 75 mm, PASP >70

27
Q

Pre mitral balloon valvuloplasty

A

Get TEE to look for LA thrombus and quantify MR

28
Q

EOA prosthetic valve
elevated velocity for aortic bioprosthetic valve

A

LVOT area * DVI
>3 m/s

29
Q

valve stenosis

A

DVI < 0.25

30
Q

AS replacement if

A

severe AS in symptomatic patients, asymptomatic patients with a reduced ejection fraction (<50%), and patients requiring other cardiac surgery.

31
Q

Severe secondary MR treatment

A

Optimize GDMT (optimize treatment of underlying LV dysfunction-cath/CRT if needed), then consider mitraclip. If anatomy is not favorable-> surgical repair

32
Q

Antibiotic ppx

A

Prior history of endocarditis, prosthetic valves or material, congenital heart disease, transplanted heart with primary valvular disease.
Use amoxicillin or IV ampicillin

33
Q

endocarditis first step

A

blood cultures, then antibiotics and TTE

34
Q

most likely endocarditis patient to derive benefit from urgent surgery

A

heart failure (HF)

35
Q

normal LVOT VTI

A

20 cm

36
Q

prosthetic aortic valve high velocity (3 m/s)

A

start with DVI
>0.25= PPM (iEOA < 0.85), high flow state (LVOT VTI high)
<0.25= thrombus (more acute) or pannus (AT will be more than 100 for both)
>0.25 + AT > 100= subvalvular narrowing or improper measurement

37
Q

most important risk factor for development of calcific aortic stenosis

A

age

38
Q

very severe AS

A

peak aortic valve (AoV) velocity of 5 m/sec. Intervene regardless of symptoms

39
Q

most common congenital valvular lesion

A

bicuspid aortic valve

40
Q

endocarditis with device involvement/ presence?

A

extraction

41
Q

Valvular afib

A

Warfarin, not DOAC. Same if prior embolic event/LAA thrombus.

42
Q

severe TR

A

VC 0.7, EROA 0.4, Systolic hepatic vein flow reversal
prominent descent of the V wave, venous systolic thrill, and tender hepatomegaly

43
Q

strep bovis endocarditis

A

also get colonoscopy, repeat in 4-6 months

44
Q

pulmonary stenosis intervention

A

valvuloplasty first line if there’s no PR, surgical repair if needed
surgical replacement if marked valvular dysplasia or hypoplasia of the annulus

45
Q

warfarin reversal
dabigatran reversal
other DOACS

A

prothrombin complex concentrate (PCC)
Idarucizumab
Andexanet alpha

46
Q

Lambl’s excresence management

A

no further testing, observation

47
Q

fibrosis and fusion of the mitral chordae, calcified leaflet tips.
calc of annulus and the base of the mitral leaflets.
Congenital absence of a papillary muscle.

A

rheumatic MS.
calcific MS.
parachute mitral valve.

48
Q

TAVR preprocedural planning

A

Cardiac and aortic CT angiography (TEE if CT would be harmful)
invasive or CT coronary angiography, dental examination to rule out potential infection sources

49
Q

most common etiology of TS [tricuspid stenosis].
severe TS.

A

rheumatic disease, associated with mitral disease.
mean pressure gradient >5 mm Hg, [PHT] ≥190 [msec], valve area ≤1.0 cm2 (continuity equation)

50
Q

asymptomatic moderate AS/AI/MR surveillance

A

1-2 years
6-12 mos for severe disease

51
Q

severe MS auscultation.

A

narrowing of the A2–opening snap interval, <80 msec.
bring out the MS rumble by having the patient perform sit-ups

52
Q

Bicuspid risk of associated disease

A

AI is highest, then AS, then ascending aortic aneurysm, then coarctation, then dissection

53
Q

end-stage renal disease on dialysis substantially increases surgical mortality risk.

A
54
Q

prosthetic mitral valve high velocity (E velocity >2), mean gradient > 5

A

iEOA < 0.9= severe PPM
PHT > 200 = stenosis

55
Q

most likely defect in Turner syndrome

A

bicuspid aortic, then coarctation

56
Q

Fungal (candida, aspergillus) endocarditis

A

surgery

57
Q

Valvular surgery follow up

A

TTE at 6-12 weeks

58
Q

most common cause of a flail leaflet

A

myxomatous disease

59
Q

MR poor prognosis

A

elevated BNP

60
Q

Avoid SAVR

A

STS> 8%, highly calcified aorta, prior chest radiation, severe lung, liver, or renal disease.

60
Q

Hill’s sign

A

systolic BP in the leg >40 mm Hg higher than in the arm: severe AI

61
Q

Aortic root repair in bicuspids

A

root >5.5 cm OR
root >5 cm if additional risk factors are present (family history of dissection, growth >0.5 cm in 1 year, coarctation) OR
root >4.5 cm if performing AVR anyway.

62
Q

staph UTI

A

think staph bacteremia despite no other signs of infection, could be subacute

ACCSAP (10 decks)

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