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
Aortic stenosis can be mild, moderate, or severe. When is a patient with severe aortic stenosis eligible for certification?
-surgically repaired
-at least 3 months post-surgery
-meets all aortic valve repair surgical guidelines
How frequently does a patient with severe aortic stenosis need to recertify? What kind of follow-up care does a patient with severe aortic stenosis require?
-annual medical exam
-annual recert
When is a patient who has severe aortic stenosis ineligible for certification?
Driver with severe aortic stenosis is ineligible unless repaired and meets post-op guidelines.
When is a patient who has had aortic valve repair eligible for certification?
-the underlying cause is known and pt is not having sxs related to the underlying cause
-at least 3 months post-surgery
-clearance from a cardiovascular specialist
How frequently does a patient who has had aortic valve repair need to recertify? What kind of follow-up care does a patient who has had aortic valve repair require?
-annual re-cert
-annual medical exam
-after surgical repair, needs 2D echo prior to hospital dischg
-additional monitoring needed based on severity of aortic regurg
When is a patient who has had aortic valve repair ineligible for certification?
-thromboembolic complications
-less than three months post-op
-no clearance from a cardiovascular specialist
-sxs of underlying dz still present
What signs and symptoms suggest poor prognosis in a patient with mitral regurgitation?
-dyspnea
-fatigue
-orthopnea (easier to breathe sitting up; harder to breathe lying down)
-paroxysmal nocturnal dyspnea
What studies do you use for initial assessment of a patient with mitral regurgitation?
-cxr
-two dimensional and Doppler echo
-xtress testing if sxs unclear
-transeophogeal echo if assessment of structural abnormalities needed
What criteria define severe mitral regurgitation?
Regurgitated volume is > 50 cc
Effective regurgitant orifice area of : 40 cm 2
Regurgitant fraction of > 55%
-2 dimension echo shows disrupted mitral valve apparatus (flail mitral leaflet) or ruptured chordate tendinae
Mitral regurgitation can be mild, moderate, or severe. When is a patient with moderate mitral regurgitation eligible for certification?
-asymptomatic
-normal LV size and function
-normal pulmonary artery pressure
How frequently does a patient with moderate mitral regurgitation need to recertify? What kind of follow-up care does a patient with moderate mitral regurgitation require?
-asymptomatic
-normal LV size and function
-normal pulmonary artery pressure
When is a patient who has mitral regurgitation ineligible for certification?
-symptomatic
- < 6 METS
-ruptured chordate or flail leaflet
-atrial fibrillation
-LV dysfunction
-thromboembolus
-pulmonary hypertension
What tests should a patient has had mitral regurgitation repair have after surgery to repair their valve?
-Chest x-ray
-two-dimensional echo with Doppler
-might also need transesophageal echo
What is req for a patient who has mild mitral regurgitation to be eligible for certification?
-annual recert
-annual medical exam
Annual echo not necessary.
What is req for a patient who has moderate mitral regurgitation to be eligible for certification?
-annual recert
-annual medical exam
Annual echo is required.
What is req for a patient who has severe mitral regurgitation to be eligible for certification?
-annual recert
-annual medical exam
Echo and exercise tolerance test req every 6-12 months.
What signs and symptoms in a patient with mitral stenosis to be concerning?
-Angina
-syncope
-fatigue
do not qualify driver was severe mitral stenosis until they are successfully treated.
Which patients who have mitral stenosis are eligible to be certified?
Those who have mild or moderate mitral stenosis and are asymptomatic. You cannot certify them if there symptomatic. They must be asymptomatic.
If a patient with mitral stenosis is certified, how often do they need to be recertified?
-Annual recertification
-annual medical exam which must include chest x-ray, echo, two-dimensional echo with Doppler or some of the study to assess severity of mitral stenosis
Can a driver was severe mitral stenosis be certified?
Only if they have had successful surgical repair. You cannot qualify driver who has severe mitral stenosis until they are successfully treated.
What are the two ways to surgically repair severe mitral stenosis?
- Percutaneous mitral valvotomy
- Commissurotomy
After surgical treatment, symptoms of mitral stenosis improve meal immediately, but recur in about 60% of people.
Under what circumstances can a driver with severe mitral stenosis who has had percutaneous mitral valvotomy be certified?
-At least four weeks postop
-clearance from cardiovascular specialist following repair
-no pulmonary hypertension
-no thromboembolic complications
-asymptomatic
-meets certification requirements of the underlying condition
-etiology is confirmed and treatment is known to be effective and safe
Under what circumstances can a driver with severe mitral stenosis who has had commisurotomy be certified?
-At least three months postop
-clearance from cardiovascular specialist following repair
-no pulmonary hypertension
-no thromboembolic complications
-asymptomatic
-meets certification requirements of the underlying condition
-etiology is confirmed and treatment is known to be effective and safe
After a driver with severe mitral stenosis has had percutaneous mitral valvotomy, what is the minimum waiting period before the driver is eligible for certification?
At least four weeks postop
After a driver with severe mitral stenosis has had percutaneous mitral valvotomy, what is the minimum waiting period before the driver is eligible for certification?
At least three months postop
What is mitral valve prolapse?
-Condition where the mitral valve does not close properly
What are some long-term health consequences of mitral valve prolapse?
-Left ventricle and left atrium enlargement
-atrial fibrillation
-heart failure
The pulmonary valve is between the right ventricle in the pulmonary artery. When is a driver who has mild or moderate pulmonary valve stenosis ineligible to be certified?
-Echo shows there’s more than moderate pulmonary valve regurgitation
-worse than mild right ventricular dysfunction on echo
-right ventricular pressure greater than 50% systemic pressure
-more than mild right ventricular hypertrophy on echo
-pulmonary valve gradient is more than 50 mmHg with normal cardiac output
-main pulmonary artery diameter more than 5 cm as measured on echo or other imaging modality
What are the two ways to repair pulmonary valve stenosis?
-Balloon valvuloplasty
-valvotomy
What is the minimum waiting period required for a driver who has had balloon valvuloplasty to repair pulmonary valve stenosis?
At least one month
What is the minimum waiting period required for a driver who has had surgical valvotomy to repair pulmonary valve stenosis?
At least three months
If a driver pulmonary valve stenosis is certified, what requirements must they meet for recertification?
-Annual recertification
-annual medical exam
-annual evaluation by cardiac specialist
Health risks are there for a patient with pulmonary valve stenosis?
-Progression is gradual
-sudden incapacitation may occur
Under what circumstances can a driver who has a prosthetic valve become certified?
-At least three months post placement
-asymptomatic
-clearance from cardiovascular specialist
If a patient has a prosthetic valve, under what circumstances can they become recertify?
