ACC AHA Part 2 Flashcards Preview

ACC/AHA Guidelines > ACC AHA Part 2 > Flashcards

Flashcards in ACC AHA Part 2 Deck (28)
Loading flashcards...
1

ACC AHA 2014 Recommendations for Medical Therapy  for Aortic Regurgitation 

  1. Class 1
    1. Treatment of hypertention (BP > 140 mmHg) is recommended in patients with chronic AR
      1. Preferably with DHPR- CCB or ACE/ARB
  2. Class IIa
    1. ACE/ARB and beta blockers is reasonable in patients who has symptoms and /OR LV dysfunction, when surgery is not performed because of comorbidities

2

2014 ACC/AHA Class I reccomendations for surgery for Aortic Regurgitation 

2014 ACC/AHA Class I reccomendations for surgery for Aortic Regurgitation 

  1. Class I 
    1. AVR is indicated for symptomatic patients with severe AR regardless of LV systolic function
    2. AVR is indicated for asymptomatic patient with chronic severe AR and LVEF < 50%
    3. AVR is indicated for patients with severe AR who are undergoing Surgery for other indications

3

ACC/ AHA 2014 Recommendation for Surgical therapy for Aortic Regurgitation

  1. Class IIa Recommendations

    1. AVR is reasonable for asymptomatic patients with severe AR, Normal LV systolic function (LVEF > 50%) but severe LV dilation (LVESD > 50mm)
    2. AVR is reasonable in patients with moderate AR undergoing other cardiac surgery (IIa)

4

ACC/ AHA 2014 Recommendation for Surgical therapy for Aortic Regurgitation

 

Class IIb Recommendations

ACC/ AHA 2014 Recommendation for Surgical therapy for Aortic Regurgitation

 

  1. Class IIb Recommendations
    • AVR may be considered for asymptomatic patients with severe AR, Normal LV systolic function (LVEF > 50%) but with progressive LV dilation (LVEDD > 56mm) if surgical risk is low)

5

Reccomendation for 

symptomatic patients with severe AI 

AVR is indictated regardless of LV function for symptomatic patient with severe AR 

Class 1 indication ACC/AHA (2014) 

6

Echo / Hemodynamic Classification of mild Aortic insufficiency 

  1. Jet width 
  2. Vena contracta 
  3. RVol 
  4. RF 
  5. ERO 
  6. Angiography grade 

  1. Jet width <25% of LVOT
  2. Vena contracta <0.3 cm
  3. RVol <30 mL/beat
  4. RF <30%
  5. ERO <0.10 cm2
  6. Angiography grade 1+

7

Echo / Hemodynamic Grading of mild AI 

  1. Jet width ?

Echo / Hemodynamic Grading of mild AI 

  1. Jet width <25% of LVOT

8

Echo / Hemodynamic Grading of mild AI 

Vena contracta?

Echo / Hemodynamic Grading of mild AI 

Vena contracta <0.3 cm

 

9

Echo/ Hemodynamic grading of mild Aortic insufficiency 

  1. RVol ?

Echo/ Hemodynamic grading of mild Aortic insufficiency 

  1. RVol <30 mL/beat

10

Echo/ Hemodynamic grading of mild Aortic insufficiency 

RF ?

Echo/ Hemodynamic grading of mild Aortic insufficiency 

RF <30%

 

11

Echo/ Hemodynamic grading of mild Aortic insufficiency 

ERO?

Echo/ Hemodynamic grading of mild Aortic insufficiency 

ERO <0.10 cm2

 

12

  • Hemodynamic / Echo criteria for Moderate AR
    1. Jet width 
    2. Vena contracta 
    3. RVol 
    4. RF 
    5. ERO 
    6. Angiography grade 

  • Hemodynamic / Echo criteria for Moderate AR
    1. Jet width 25%–64% of LVOT
    2. Vena contracta 0.3–0.6 cm
    3. RVol 30–59 mL/beat
    4. RF 30%–49%
    5. ERO 0.10–0.29 cm2
    6. Angiography grade 2+

13

Hemodynamic / Echo criteria for Moderate AR? 

Jet width ? % of LVOT

 

Hemodynamic / Echo criteria for Moderate AR? 

Jet width 25%–64% of LVOT

 

14

Hemodynamic / Echo criteria for Moderate AR? 

Vena contracta ?

Hemodynamic / Echo criteria for Moderate AR? 

Vena contracta: 0.3–0.6 cm

 

15

Hemodynamic / Echo criteria for Moderate AR? 

RVol?

Hemodynamic / Echo criteria for Moderate AR? 

RVol: 30–59 mL/beat

 

16

Hemodynamic / Echo criteria for Moderate AR? 

RF ?

Hemodynamic / Echo criteria for Moderate AR? 

RF 30%–49%

 

17

Hemodynamic / Echo criteria for Moderate AR? 

ERO ?

Hemodynamic / Echo criteria for Moderate AR? 

ERO 0.10–0.29 cm2

 

18

  • Hemodynamic/Echo criteria of  Severe AR:
    1. Jet width 
    2. Vena contracta 
    3. Abdominal aorta flow ? 
    4. RVol 
    5. RF 
    6. ERO 
      1. Angiography grade 

  1. Severe AR:
    1. Jet width _65% of LVOT
    2. Vena contracta >0.6 cm
    3. Holodiastolic flow reversal in the proximal abdominal aorta
    4. RVol _60 mL/beat
    5. RF _50%
    6. ERO _0.3 cm2
    7. Angiography grade 3+ to 4þ+

19

Reccomendations for AI in 

Asymptomatic 

Chronic / Severe AI 

LVEF < 50%

Class 1 indication for surgical AVR 

2014 ACC/AHA 

20

Diagnosis of chronic Severe AI 

  1. diagnosis of  chronic severe AR requires evidence of LV dilation

21

Reccomendations for: 

asymptomatic 

severe AR 

Normal LVEF (>50) 

LVESD > 50mm 

AVR is reasonable 

Class IIa rec (ACC/AHA 2014 )

22

Reccomendation for 

Moderate AI undergoing other cardiac surgery

AVR is reasonable 

Class IIa Reccomendation (Class IIa ACC/AHA 2014) 

23

Reccomendations for 

Severe AI 

Asymptmatic 

LVEF > 50% 

LVEDD > 56 

AVR is reasonable if surgical risk is low 

Class IIb 

(ACC/ AHA 2014 ) 

24

Reccomendations for Mitral balloon valvuloplasty 

 level I evidence supports balloon valvuloplasty for:

an asymptomatic patient 

moderate mitral valve stenosis,

 resting pulmonary artery pressure is greater than 50 mmHg,

left atrial thrombus.

25

Decision pathway if patient has 

Echocardiographic Severe 

Asymptomatic aortic stenosis 

1. if their LVEF (<50%) - Class 1A recommendation is for surgery 

2. if they are undergoing some other heart surgery -- Class 1 rec is to fix it 

3. if they have super severe AS (Vmax > 4)  classII is surgery 

4. if they have poor ETT then surgery 

26

ACC / AHA guidelines for - 

tricuspid valve disease in the absence of mitral disease

Class IIa - Severe TR in Symptomatic patients 

 

Other issues: 

TV annulus size > 40mm 

RV function 

Pulmonary HTN (>50mmHg at rest or 60mmHg exercise) 

27

when to replace the tricuspid valve in the setting of mitral valve surgery 

Class I : Severe TR 

Class II: Severe TR with pulmonary HTN OR tricuspid annulus > 40 

28

medical therapy for secondary mitral regurgitation 

Chronic secondary MR and HF with reduced LVEF should receive GDMT including 

ACE /ARB 

BB 

Aldosterone antagonist