Valvular Heart Disease Flashcards
Significant pulmonary hypertension occurs when pulmonary artery pressure is ______ of systemic blood pressure.
> 50%
Pulmonary hypertension can occur with or without core pulmonary. What is core pulmonary?
enlargement of right ventricle secondary to disorders affecting lung structure or function
If a patient has pulmonary hypertension, under what condition can you certify the driver?
Nature and severity of the medical condition doesn’t endanger health and safety of driver public
If the patient with pulmonary hypertension is certified, what are the criteria for recertification?
-Recertification annually
-obtain additional testing on a case-by-case basis
Under what circumstances are you unable to certify a patient with pulmonary hypertension?
-Partial pressure of arterial oxygen is less than 65 mmHg
-dizziness
-hypotension
-dyspnea addressed
Name the main types of valvular heart disease.
- Aortic regurgitation
- aortic stenosis
- mitral regurgitation
- mitral valve prolapse
- pulmonary valve stenosis
Chapter objectives indicate that it’s important to know how to define the grade of a murmur. Describe the grades of murmurs.
Grade I: must strain to hear the murmur
grade II: can hear faint murmur without straining
grade III: can easily hear a moderately loud murmur
grade IV: can easily hear a moderately loud murmur that has a thrill
grade V: can hear the murmur when only part of the stethoscope is touching the skin
grade VI: can hear the murmur with a stethoscope close to the skin; stethoscope doesn’t have to be touching the skin to hear the murmur
Which heart murmurs are considered to be benign?
Systolic, mid systolic, and grades one and two are usually benign if the driver has no signs or symptoms of heart disease
-if the driver has symptoms of heart disease and has one of the above murmurs, specialist evaluation is recommended
any patient with grade 3 or higher murmur needs specialty consultation
patients with whole systolic, late systolic, diastolic, and continuous murmurs needs specialty consultation
When can you certify a patient who has mild aortic regurgitation? For how long can such a patient certified?
-can certify patient with mild, moderate, or severe aortic regurgitation if they are asymptomatic
-must recertify annually
-requires annual medical exam
-requires echo every 2 to 3 years
How frequently does a certified driver with mild aortic regurgitation need to be certified? What kind of follow-up do they need?
-must recertify annually
-requires annual medical exam
-requires echo every 2 to 3 years
When is a patient who has mild aortic regurgitation ineligible for certification?
-pt is symptomatic
When can you certify a patient who has moderate aortic regurgitation? For how long can such a patient certified?
-can certify patient with mild, moderate, or severe aortic regurgitation if they are asymptomatic
-normal left ventricular function
-no or mild left ventricle enlargement
-can certify them annually
-needs annual medical exam
-must have echo every 2 to 3 years
How frequently does a certified driver with moderate aortic regurgitation need to be certified? What kind of follow-up do they need?
-Requires annual recertification and annual medical exam
-echo every 2 to 3 years
When is a patient who has moderate aortic regurgitation ineligible for certification?
-Symptomatic
-left ventricular function is abnormal
-more than mildly particular enlargement
When can you certify a patient who has severe aortic regurgitation? For how long can such a patient certified?
-can certify patient with mild, moderate, or severe aortic regurgitation if they are asymptomatic
-normal left ventricular function
-LV dilation with LVEDD less than or equal to 60 mm and LVESD less than or equal to 50 mm
-at least three months post operative
-cleared by cardiologist
How frequently does a certified driver with severe aortic regurgitation need to be certified? What kind of follow-up do they need?
-Must be certified every six months if not surgically repaired
-certified annually post-aortic valve repair
-echo every 6 to 12 months if LVEDD less than or equal to 60 mm or LVESD less than or equal to 50 mm
-echo every 4 to 6 months if LVEDD = 60 mm or LVESD =50 mm
When is a patient who has severe aortic regurgitation ineligible for certification?
-Symptomatic
-patient’s maximal workload is less than six metabolic equivalents
LVEF < 60
LV dilation with LVEDD greater than 70 mm or LVESD greater than 55 mL
Aortic stenosis can be mild, moderate, or severe. When is a patient with mild aortic stenosis eligible for certification?
Aortic stenosis = narrowing of the aortic valve
-stenosis is surgically repaired and driver is at least 3 months post surgery
-asymptomatic
How frequently does a patient with mild aortic stenosis need to recertify? What kind of follow-up care does a patient with mild aortic stenosis require?
-annual medical exam
-annual recert
-echo every 5 years
When is a patient who has mild aortic stenosis ineligible for certification?
Driver is symptomatic
Aortic stenosis can be mild, moderate, or severe. When is a patient with moderate aortic stenosis eligible for certification?
-stenosis is surgically repaired and driver is at least 3 months post surgery
-asymptomatic
-no disqualifying findings or conditions
How frequently does a patient with moderate aortic stenosis need to recertify? What kind of follow-up care does a patient with moderate aortic stenosis require?
-annual medical exam
-annual recert
-echo every 1-2 years
When is a patient who has moderate aortic stenosis ineligible for certification?
- Symptomatic
- Heart failure
- Angina
- Atrial fibrillation
- LV dysfunction with ejection fraction < 50%
- thromboembolism
