Valvular Disease

Question 1

What type of aortic stenosis is present in the following age groups: 1) < 30 yo, 2) 40-60 yo, 3) > 70 yo

Answer 1

1) Univalvular or Bicuspid Valve disease
2) Bivalvular disease or Rheumatic Aortic Valve Dz
3) Calcific Aortic Valvular Dz (Most common cause)

Question 2

What medication do ALL prosthesis require?

Answer 2

ASA!!!

Question 3

What is the INR goal for mechanical Aortic Valve?

Answer 3

2.0-3.0

Remember treat with ASA and Warfarin

Question 4

How do you treat chronic Aortic Regurgitation?

Answer 4

Treat the patients HTN, treat with afterload reduction via either ACE/ARB or vasodilators.

Valve replacement indicated for patients that are symptomatic from the AR, or have an EF < 50%.

Question 5

What aortic disease often is associated with Bicuspid Aortic Valve? When should surgical intervention for the association occur?

Answer 5

Aortic Aneurysm

Surgical intervention when the Aneurysm > 5.5 cm, or when increasing in size >0.5 cm in 1 years time.

Question 6

What is the most important medication for mitral stenosis? Why?

Answer 6

Beta-Blockers

Mitral Stenosis and the cross valve gradient is HEART RATE dependent, meaning that the faster the heart rate the higher the gradient, if you control the HR to a reasonable rate —> you can minimize the extent of the valvular gradient.

Question 7

If a patient has mitral stenosis + A Fib (ie: valvular A Fib) what is the anticoagulation of choice? Does CHADS Score play effect here?

Answer 7

Warfarin!!!

No.

Question 8

What indications for mitral stenosis valvular balloon valvuloplasty? Contraindications?

Answer 8

1) NYHA Class III-IV symptoms, 2) A fib, or 3) Pulmonary HTN

Contra:

1) Presence of atrial thrombus
2) Evidence of Moderate or Severe Mitral Regurgitation

Question 9

What is the INR goal for mechanical Mitral Valve Replacement?

Answer 9

2.5-3.5

Remember, also NEED ASA!