Valvular Heart Disease

Question 1

in aortic stenosis, which drugs to avoid

Answer 1

vasodilators, diuretics, statins

Question 2

why avoid diuretics in aortic stenosis

Answer 2

decreased cardiac output

Question 3

why not use statins in aortic stenosis

Answer 3

they are ineffective to prevent progression of calcification

Question 4

in aortic regurgitation, when are beta blockers useful

Answer 4

in acute AR due to aortic dissection because they reduce sheer stress and decrease lesion propagation. avoid in other causes besides aortic dissection

Question 5

in mitral stenosis, what medications should be used

Answer 5

for concurrent AFib use rate control. beta blockers can help in exercise-induced symptoms but little supporting evidence

Question 6

in mitral regurgitation, what medications should be used

Answer 6

vasodilators such as sodium nitroprusside and nicardipine can improve hemodynamic compensation. use GDMT for HF with LV dysfunction

Question 7

causes of aortic stenosis?

Answer 7

calcification of aortic valve, congenital bileaflet valve, rheumatic heart disease

Question 8

causes of aortic regurgitation?

Answer 8

congenital abnormality (bicuspid aortic valve), calcific valve disease, age-associated deterioration, rheumatic heart disease, infective endocarditis

Question 9

causes of mitral stenosis?

Answer 9

almost exclusively rheumatic heart disease

Question 10

causes of mitral regurgitation?

Answer 10

mitral valve prolapse, distorted papillary muscles from myocardial damage (CAD), simple dilation of LV–> stretch & pulling apart mitral valve (result of HF)

Question 11

what is the drug recommendation for bioprosthetic valves

Answer 11

VKA goal INR 2.5 is reasonable for 3-6 months for AVR or MVR if low bleed risk, they don’t need to be on it forever, only until tissue valve has been endothelialized. they should be on lifelong aspirin 75-100 mg daily tho

Question 12

what is the drug recommendation for bileaflet or single-tilting disk AVR

Answer 12

aspirin 75-100 mg daily, VKA goal INR 2.5

Question 13

what is the drug recommendation for caged ball (older gen) or MVR

Answer 13

aspirin 75-100 mg daily and VKA goal INR 3

Question 14

what is the drug recommendation for on-x

Answer 14

aspirin 75-100 mg daily and VKA goal INR 1.5-2 after first 3 months with a goal INR 2-3

Question 15

what is the drug recommendation for TAVR

Answer 15

aspirin 81 mg daily. VKA goal INR 2.5 may be reasonable for 3 months. alternative: aspirin 75-100 mg daily + clopidogrel 75 mg daily for 3-6 months

Question 16

what is the drug recommendation for mitraclip

Answer 16

Aspirin 325 mg daily for 6-12 months + clopidogrel 75 mg daily for 1 month