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Cardio > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

Symptomatic MS- intervene if MVA is —-

A

1.5 or less

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2
Q

If MVA is less than 1 and pt asymptomatic what to do

A

If valve suitable for BMV-do it . IIb:Otherwise monitor

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3
Q

Severe MS is

A

MVA 1.5 or less- ACC/AHA-2014
Moderate MS is 1.6-2 cm2
Very Severe MS is 1 cm2 or less

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4
Q

Stage B or Progressive MS is MVA of

A

More than 1.5 and pressure half time < 150

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5
Q

ACC/AHA classification of VALVE diseases

A

Stage A-at risk;
B- progressive
C-Asymptomatic
D-Symptomatic

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6
Q

PASP for decisions on MS

A

50 mm Hg

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7
Q

MV replacement indications in MR i.e. The definite indications

A
  1. symptoms+EF>30
  2. Asymptomatic and LVESD at least 40

If in symptomatic pts EF 30 or less a weak recommendation is that Mitral Valve repair can be considered

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8
Q

Role of Afib and PASP in deciding MV surgery

A

Asymptomatic Severe MR with Afib or PASP >50 can consider REPAIR if success high

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9
Q

Mitral valve repair best with–//

Chordal rupture repair best with

A

Posterior leaflet

Posterior chordal rupture

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10
Q

Mitral valve cusp at intervalvular fibrosa

A

A3 cusp

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11
Q

Pml forms — part of annulus

A

5/8

But Total area of Aml and pml are same in systole

The name of commissures come from the papillary muscles - anterolateral and posteromedial

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12
Q

Most commonly fused cusps in Bicuspid Aortic valve

A

Right and left

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13
Q

Difference between rheumatic and degenerative AS in Echo is

A

Degen-near Aortic ring. Rheumatic less involvement near the ring

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14
Q

Effect of ARB or Betablocker in ascending aortopathy of Bicuspid Aortic valve

A

No studies demonstrated benefit.2014 ACC/AHA did not recommend any pharmacologic treatment in the absence of another indication like HTN

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15
Q

When to do Surgery for Aorta in Bicuspid Aortic valve

A
  1. > 5.5 cm at root or Asc Aorta

2. If growth rate >.5cm/year or if surgical risk <4%ie expert centre or families history of dissection consider at 5 cm

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16
Q

VCW in Severe MR

A

0.7 cm or more

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17
Q

0.3cm VCW is mild or mod MR

A

Moderate MR

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18
Q

E velocity in Severe MR

A

More than 1.4 cm/s

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19
Q

E/A ratio in Severe MR

A

2 or more

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20
Q

V wave cut off sign indicates

A

Severe MR in CWD

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21
Q

Surface velocity of PISA is

A

Equal to the chosen Aliasing velocity

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22
Q

Effectiveness of PISA in quantifying MR

A

Moderate accuracy

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23
Q

EROA by PISA eqn

A

2#r 2 x aliasing vel. / peak MV vel

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24
Q

Normal pulmonary venous flow during Doppler

A

Antegrade in both systole and diastole with systole dominant

With slight retrograde flow during atrial syst

In Severe MR-Systolic flow reversal

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25
Q

The mean gradient in MS is above

A

10 mm Hg

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26
Q

Oral penicillin prophylaxis for RHD

A

Penicillin V 250 mg BD

If allergic..Azithromycin 250 mg OD

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27
Q

In the absence of MS E velocity more than—— suggests Severe MR

A

More than 1.5 m/s

28
Q

BMV during pregnancy is done at

A

AFTER 20 wks of gestation

29
Q

How to get EROA by PISA

A

Measure PISA radius
Measure MR VTI

Machine will give you EROA and Regurgitant volume

To calculate RFraction –divide RV by RV + Aortic VTI

30
Q

VCW in Severe AR

A

MORE than 6 mm

31
Q

How to measure mitral Antero- Postr diameter

A

In PLAX view

32
Q

Mitral annular dilatation Echo criteria

A

Mitral AP diameter/ Length of Anterior leaflet in diastole More than 1.3 or When diameter is more than 35

33
Q

The normal decrease in Mitral annular area in systole is

A

25%

34
Q

Acute rheumatic fever occurs —wks after GAS infection

A

2-4 wks

35
Q

Clinical features of ARF( rheumatic fever)

A

ACCESS- Arthritis, Carditis, Chorea, Erythema marginatum, Subcutaneous nodules

36
Q

Most common manifestation of ARF

A

Carditis -50-70%

Then Arthritis

37
Q

Penicillin used for ARF prophylaxis

A

Penicillin G Benzathine

ORAL is Penicillin V 250 BD or Azithromycin 250 OD

38
Q

Aortic finding in AR

A

proximal ABDOMINAL Aorta shows holodiastolic flow reversal in Severe AR

39
Q

Role of M Mode in MVP diagnosis

A

No role

40
Q

Indications for surgery in Severe AR

A
  1. Symptoms
  2. EF< 50%
  3. ESD >50mm
  4. EDD> 65 mm of low risk.

All are independent. Uptodate 2018

41
Q

Mild Aortic stenosis

A

ASE 2017 Guidelines-2.5 or less is Aortic sclerosis
2.6 is mild Aortic stenosis

3m/s is Moderate or mean of 20 -40 is Moderate

41 Mean is Severe

42
Q

Key parameter to diagnose low gradient normal EF Aortic stenosis

A

Stroke volume index < 35ml/m2

For low gradient low EF - do DSE

43
Q

Life span of metallic prosthetic valve

A

20-30 yrs

44
Q

TTK chitra is a

A

Tilting disc valve

45
Q

Acute Rheumatic fever major criteria in order of frequency

A

CACSE

Carditis, Arthritis, Chorea, Subcutaneous nodules, Erythema marginatum

46
Q

Doppler findings in Rheumatic Valvulitis

A

MR-2 views, 2 cm in length,peak velocity 3m/s And Pansystolic jet ( All 4 required)

AR- same as above but 1 cm length and pan diastolic

47
Q

The Arthritis of ARF lasts for around…..with or without therapy

A

4 weeks

48
Q

How long you will need NSAIDs for Arthritis treatment

A

1-2 weeks usually. Sometimes upto 8 weeks

49
Q

CRP And ESR monitoring in ARF treatment

A

CRP twice weekly then every one to two weeks till normal

ESR may stay elevated for upto 2 months after a transient inflammatory stimulus. CRP normalizes over matter of days once inflammation subsided

Uptodate 2017

50
Q

No of randomized trials done for TAVR vs surgery b/w 2012 and 2017

A

5

51
Q

Aortic valve velocity in mild AS

A

ASE 2017 Guidelines-2.5 or less is Aortic sclerosis

2.6 is mild Aortic stenosis

52
Q

ESC 2017 recommendation on TAVI - broadly speaking

A

TAVI for high risk

SAVR for low risk esp younger pts Intermediate risk- bla bla

53
Q

Mean age of TAVI trials as of 2017

A

80 yrs

Can we apply this data to those below 70?

54
Q

——-&——-are more in TAVI than SAVR

A

Paravalvular leak and need of PPI

55
Q

ESC position on NOAC in MR and Aortic Valve disease

A

Can give

But contraindicated in MS and Mechanical valves

56
Q

Penicillin used for RHD prophylaxis

A

Penicillin V 250 mg BD

57
Q

All severe regurgitations have ……..shape in CW

A

Triangular with early peak .
Otherwise it’s meso(mid)systolic peak . May not be always. But triangular means severe

From Internet

58
Q

Acute Rheumatic Arthritis may need treatment upto ….

A

8 weeks

Most will respond in 1-2 weeks. Then you can try reducing

59
Q

In acute Rheumatic fever If response to Aspirin doesn’t occur in ….. hrs suspect the diagnosis

A

24-36 hours ( Chorea doesn’t respond)

60
Q

Number of RCTs between 2012 and 2017 on TAVR

A

5 studies

61
Q

Why TAVI not preferred in younger patients

A
  1. No long term data on durability of TAVI valves
  2. Trials were on pts with mean age of 80
  3. Paravalvular leak and need of PPI higher with TAVI.

ESC 2017

62
Q

NOAC in valvular heart disease

A

Aortic valve disease and Mitral regurgitation -suffficient data to use.

ESC 2017

Not in significant MS

63
Q

Most important risk factor for death and disability after successful correction of valvular lesion

A

Residual Pulmonary Hypertension

64
Q

Which study showed Sildenafil is not effective in residual PAH in Valvular lesions

A

2017 SIOVAC trial

65
Q

30 day all cause mortality after TAVI

Also 1 yr mortality rate

A

1 year- around 20%

30 day around 10%

66
Q

Aortic sclerosis definition

A

Velocity < 2m/s with thickened Aortic Valve

Uptodate -seems to be wrong

ASE 2017 Guidelines-2.5 or less is Aortic sclerosis
2.6 is mild Aortic stenosis

67
Q

Best view for VCW of mitral valve

A

PLAX

JACC article 2012

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