Cardiovascular Vivas Flashcards

1
Q

What is used for biological (bioprosthetic) valve replacement?

A

Bovine or porcine

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2
Q

What is the most common mechanical valve used?

A

Bileaflet valve
(ball and cage now rarely used)

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3
Q

What is the major disadvantage of biological valves?

A

Structural deterioration + calcification
May require future replacement, posing additional risks

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4
Q

What is the major advantage of biological valves?

A

Lower risk thrombogenesis
Long term anticoagulation not usually needed
Warfarin maybe given for first 3 months depending on patient factors

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5
Q

Describe the use of aspirin in biological valves

A

Low dose aspirin given longterm

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6
Q

In which patient group are biological valves preferred?

A

> 65s for aortic valves
70s for mitral valves

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7
Q

What is the main advantage of mechanical valves?

A

Greater longevity +
low failure rate

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8
Q

What is the major disadvantage of mechanical valves?

A

Increased risk of thrombosis meaning long term anticoagulation is needed

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9
Q

What is the preferred form of anticoagulation for patients with mechanical heart valves?

A

Warfarin

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10
Q

What is the target INR for aortic and mitral mechanical valves?

A

Aortic: 3.0
Mitral: 3.5

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11
Q

Describe the use of aspirin in mechanical valves

A

Only given if additional indication e.g. IHD

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12
Q

What are the guideline regarding prophylaxis of endocarditis in patients with valve replacements?

A

No abx recommended for common procedures

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13
Q

3 features of typical Anginal chest pain

A
  1. Constricting discomfort in front of chest, neck, shoulders, jaw or arms
  2. Precipitated by physical exertion
  3. Relieved by rest or GTN in ~5 mins
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14
Q

4 Midline sternotomy causes

A

Open aortic/ mitral valve surgery
Coronary artery bypass grafting (CABG)
Cardiac transplant
Correction of congenital cardiac defects

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15
Q

4 symptoms of aortic stenosis

A

Fatigue
Dyspnoea
Exertional syncope
Exertional angina

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16
Q

Mx of AS

A

Asymptomatic: monitor
Symptomatic: valve replacement
Asymptomatic but valvular gradient > 40 mmHg + features such as LV systolic dysfunction, consider surgery

17
Q

First line Mx of symptomatic AS

A

Open AV replacement
High operative risk: Transcatheteric AV implantation (TAVI= repair without need for removal)

18
Q

3 aetiologies of mitral regurgitation

A

Ischaemic: papillary muscle rupture post MI
Non-ischaemic: IE, RHD
Iatrogenic: rare, due to trauma of leaflets/ chords e.g. in TAVI

19
Q

Acute MR symptoms

A

Sudden + marked increase in congestive HF Sx, with weakness, fatigue, dyspnoea, respiratory failure + shock.
a/w peripheral vasoconstriction, pallor, + diaphoresis.

20
Q

2 Chronic MR symptoms

A

Exertional dyspnoea
Fatigue

21
Q

4 causes of chronic AR due to valve disease

A

Rheumatic fever: most common cause in developing world
Calcific valve disease
CTDs e.g. RhA/ SLE
Bicuspid aortic valve (affects valves + aortic root)

22
Q

5 causes of chronic AR due to aortic root disease

A

Bicuspid aortic valve (affects both valves + aortic root)
Spondylarthropathies (e.g. Ank spond)
HTN
Syphilis
Marfan’s, Ehler-Danlos syndrome

23
Q

2 causes of acute AR

A

Infective endocarditis
Aortic dissection

24
Q

Symptoms of AR

A

Asymptomatic
Exertional dyspnoea
Angina
HF Sx: Orthopnoea, PND, pulmonary oedema

25
Q

Mx of AR

A

Medical Mx of any associated HF
Surgery:
Symptomatic patients with severe AR
Asymptomatic patients with severe AR + LV systolic dysfunction

26
Q

Investigation of choice for aortic dissection

A

CT angiography of the chest, abdomen + pelvis
False lumen
Suitable for stable patients + for planning surgery

27
Q

Investigation for aortic dissection in unstable patients

A

Transoesophageal echo

28
Q

What causes rheumatic fever?

A

Immunological reaction to a recent (2-4w ago) Streptococcus pyogenes infection.