Valvular Disease

Question 1

Aortic valve dz: types, incidence

root requirements

Answer 1

bicuspid- 1-2%- most do not stenos- ass ao root, coarct
rheumatic- requires mv involvement

if root >4.5 cm, replace with @ time of surg,<4.0 do not replace

Question 2

Aortic stenosis: phys findings

Answer 2

more severe: becomes later peaking then obscures second heart sound

Question 3

echo findings for severe AS

Answer 3

mean grad >40mmHg
peak >4m/sec
a1xv1/v2=v2

Question 4

AS equations

Answer 4

Gorlin: CO/ HRxSEPx44.3x sqr gradient
Hakki: CO/ sqr gradient

Question 5

AS symptom survival

Answer 5

angina: 5 yrs
syncope: 3 yrs
chf: 2 yrs

Question 6

AI measurements echo:

Answer 6

vena contracta .6 severe
t1/2: 450 mild
LVOT >60% (unless eccentric)
ao reversal of flow: inital velocity >.6m/sec and .2 m/sec holodiastolic severe

Question 7

Acute AI findings:

Answer 7

physical findings may not be present, lv not dilated

echo may have diastolic MR

Question 8

AI surg indications

Answer 8

for chronic

lv dilating ES>55 ED >75

Question 9

echo eval of mitral stenosis

Answer 9

planimetry ok/ p1/2 time good
mild 1.5-2.0
mod 1-1.5
severe< 1.0

Question 10

physical exam mitral stenosis

Answer 10

dias murmur

opening snap of ms correlates with la pressure therefore, earlier os then higher pressure

Question 11

Wilkins score

Answer 11

leaf thickening
leaf mobility
leaflet calicification
subvalvular thickening
best score 4, worst 16  if less than 8 favorable valvulplasty

Question 12

Padial score

Answer 12

mv scoring- more emphasis on leaflet calcification

Question 13

pressure 1/2 time

Answer 13

220/ t1/2

longer filling more stenosis

Question 14

mr area quantification

Answer 14

40% severe

rather crude measurement

Question 15

MR regurg oriface area

Answer 15

40 severe

Question 16

indication for MR surgery

Answer 16

severe with any symptoms
	med rx of EF55 chordal preservation unlikely
asymptomatic severe
	low risk
	severe mr with dys ef40

Question 17

ischemic mr success

Answer 17

28% return with 3-4+ mr @ 6 mths

with ischemic mr

Question 18

pulmonic stenosis grading

Answer 18

mild 4m/sec

Question 19

endocarditis

Answer 19

2 culture> 12 hr apart, persistant pos culture
veg (oscil mass in path of regurg)
new regurg
partial dehiscence
abcess ; minor:heart condition, drug use, fever, immunolog., vasc phenom

Question 20

abx prophylaxisis

Answer 20

only high risk

prev endocarditis, prosth valve, unrepaired cyanotic, card transplant with regurg lesion

Question 21

anticoag for prosthetic valves

risks factors?

Answer 21

low dose asa in bio and mechanical
comadin 2-3.0 mech avr with no rf
risk factors (afib, prev thromboembolic, hypercoag, low ef)
all others 2.5-3.5 inr

Question 22

embolic event with prosthetic valve

Answer 22

inf goal inr 2-3 then increase to 2.5-3.5

if 2.5-3.5 then increase to 3.5-4.5

Question 23

prosthetice valve

Answer 23

if bileaf avr, no risk factors, no bridge

other mechanical valves or with rf need bridge

Question 24

hemolysis prosthetic valves

labs

Answer 24

increased ldh
micro anemia
schistocytes
decreased haptoglobin

Question 25

Frequency of valves in endocarditis

Answer 25

Mv> av> tv> pv

Bio and mechanical similar ie risk

Question 26

Antiarrythmics in afib/renal insuffiency

Answer 26

No cad 1c- flecainide

Renal insuffiency - no sotolol, dofetilide,

Question 27

Holo systolic murmur

Answer 27

Thru S2 without change of character

Question 28

Decreasing lv volume and MVP - phy exam

Answer 28

Moves click closer to S1 therefore lengthening the murmur

Question 29

Bernheim sign

Answer 29

Effect actually

RV failure with AS due to septal Impairment of RV

Question 30

LV dimension for surg in AI

Answer 30

> 5.0 cm