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Cardiology > 02.18b Surgical Management for Valvular Heart Disease > Flashcards

02.18b Surgical Management for Valvular Heart Disease Flashcards

1
Q

Etiology of MS

A

Rheumatic fever

RHD

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2
Q

Pathophysiology of MS

A

Leaflet thickening or calcification
Commissural fusion
Chordal fusion and shortening

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3
Q 
Exertional dyspnea
Decreased exercise capacity
Orthopnea/paroxysmal nocturnal dyspnea
Hemophysis and pulmonary edema
Pulmonary hypertension
Afib
A

MS

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4
Q

Auscultatory findings in MS

A

Increased first heart
Opening snap
Apical diastolic rumble

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5
Q

Primary cause of mortality for MS

A

Progressive pulmonary and systemic congestion

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6
Q

CXR findings for MS

A

Straight left border (left atrial enlargement, pulmonary artery enlargement)
Double contouring

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7
Q

For ruling out left atrial appendage thrombus and Mr severity for percutaneous mitral balloon valvotomy candidates

A

Transesophageal echocardiography

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8
Q

First choice of treatment for MS

A

Percutaneous mitral balloon valvotomy

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9
Q

lf not amenable for valvotomy

A

Commissurotomy

Mitral valve repair or replacement

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10
Q

Etiology of MR

A 
Mitral valve prolapse
RHD
CAD
Infective endocarditis
Certain drugs
Collagen diseases, carcinoid diseases
Trauma
Previous chest radiation
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11
Q

Apical holosystolic murmur and forceful apical impulse

Transmitted to the left axilla or left sternal border

A

MR

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12
Q

Insufficiency occurs secondary to annular dilatation or leaflet perforation with normal leaflet motion

A

Type I

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13
Q

Thickened leaflet prolapsed, or ruptured or elongated chordae tendinae with increased leaflet motion
Myxomatous conditions, MVP

A

Type II

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14
Q

Restricted leaflet motion

RHD, chronic ischemic MR

A

Type III

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15
Q

If you have MR, what to find in ECG

A

LA and LV enlargement

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16
Q

Evaluate LV size and function, RV and LA size, PA, MR severity
To evaluate MR mechanism

A

Transthoracic echocardiograph

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17
Q

Establish anatomic basis of MR to assess feasibility of repair, and guide the repair

A

TEE

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18
Q

Indications of surgical intervention for patients with MR

A

Any symptomatic patient with MR
Asymptomatic severe MR with LV systolic dysfunctions
*Recent onset of Afib, pulmonary HPN, abnormal response to stress testing

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19
Q

Treatment of choice for MR

A

Mitral valve repair

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20
Q

Etiologies of AS

A

Calcification
Congenital
Rheumatic

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21
Q

Pathophysiology of AS

A

Pressure overload

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22
Q 
Exertional dyspnea
Angina
Syncope
Decreased exercise capacity
Heart failure
A

AS

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23
Q

Harsh, crescendo-decrescendo
Systolic murmur at right 2nd ICS
Radiating to carotid arteries

A

AS

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24
Q

ECG findings in AS

A

LV hypertrophy

Conduction abnormalities, Afib

25
Q

Exercise testing of AS

A

Dobutamine stress echocardiography

26
Q

Procedure for AS with CAD risks, symptomatic but inconclusive results in non invasive tests regarding AS severity

A

Cardiac catheterization

27
Q

Management of AS

A

Medical therapy
Aortic balloon valvotomy
Surgery

28
Q

Etiology of AR

A 
Aortic root disease
Congenital 
Calcific degeneration
Rheumatic disease
Infective endocarditis
Myxomatous degeneration
29
Q

What will happen if the heart keeps pumping blood to the aorta and blood keeps coming back

A

Left ventricular dilatation

30
Q

AS is ______

AR is ______

A

Pressure overload

Volume overload

31
Q

High pitched decrescendo diastolic murmur in 3rd ICS

A

AR

32
Q

Bounding pulses quickly collapsing pulses

A

Corrigan’s sign

33
Q

Pistol shot sounds by auscultation

A

Traube sign

34
Q

ECS findings in AR

A

Left axis deviation

Intraventricular conduction defects

35
Q

Assess the severity, cause of AR, degree of pulmonary HPN

A

TTE

36
Q

Considered surgical emergency in AR

A

With aortic dissections

Infectious endocarditis with severe AR in failure

37
Q

Has traditionally been performed through a median sternotomy incision

A

Aortic valve replacement

38
Q

Types of surgery

A

Aortic valve replacement

Aortic valve repair

39
Q

Etiology of TS

A

Organic (rheumatic fever, endocarditis, rarely trauma)

40
Q

Etiology of TR

A

Functional (mitral valve disease, pulmonary hpn, RV failure)

41
Q

Pathophysiology of TR/TS

A

Elevated RA pressure

Right heart failure

42
Q

Signs of severe TS

A 
Jugular vein distension
Hepatomegaly
Splenomegaly
Ascites
Lower extremity edema
43
Q

Diagnosis of TS

A 
CXR
TTE (size, structure, motion)
44
Q

Management of TS

A

Tricuspid valve repair

Tricuspid valve replacement

45
Q

Pathology of multivalve disease

A

Rheumatic heart disease
Calcific disease
Marfan syndrome
Secondary to another valve pathology

46
Q

Advantages of mechanical aortic prosthesis

A

Highly durable

Minimized risk for reoperation

47
Q

Disadvantages of mechanical aortic prosthesis

A

Require permanent anticoagulation (warfarin)
Risk of hemorrhagic complications
Lifestyle changes

48
Q

Types of valve of mechanical aortic prosthesis

A

Ball-cage valve (Starr-Edwards)
Single titling disc (Medtronic-Hall, Ominicarbon)
Bileaflet prosthesis

49
Q

Advantagaes of biologic valves

A

Less thrombogenic
Less anticoagulant-related complications
Good for older population

50
Q

Disadvantages of biologic valves

A

More prone to structural failure

Higher chance of reoperation

51
Q

Types of biologic valves

A

Stented and non-stended heterografts
Homografts
Autografts (pulmonic valve auto-transplantation, Ross operation)

52
Q

Recommendation for warfarin INR 2-3

A

Increase INR to 2.5-3.5

53
Q

Recommendation for warfarin INR 2.5-3.5

A

Increase INR to 3.5-4.5

54
Q

Recommendation for no aspirin

A

Starts ASA 75-100mg

55
Q

Recommendation for warfarin plus ASA

A

May increase ASA to 325mg

56
Q

Recommendation for ASA alone

A

Increae ASA to 325mg or add Clopidogrel 75 mg OD and/or warfarin

57
Q

What level of INR is at higher risk for hemorrhage

A

> 5

58
Q

What to do when INR is 5-10 and not bleeding

A

Withhold warfarin, serial INR
Vit K1 (phytonadione)
Restart warfarin

59
Q

What to do in emergency cases of bleeding

A

Transfuse fresh frozen plasma

Low dose Vit K

Cardiology (13 decks)

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