Aortic Stenosis

Question 1

What is range velocity for mild to critical stenosis for AS?

Answer 1

mild < 3 m/sec
moderate 3–4
severe 4 - 4.5
critical > 4.5

Question 2

What is range aortic valve area for normal to critical stenosis for AS?

Answer 2

normal 2.5 - 4.0 cm2
mild 1.5 - 2.0 
moderate 1.0 - 1.5 
severe 0.7 - 1.0 
critical < 0.7

Question 3

What is range mild transvascular gradient for mild to critical stenosis for AS?

Answer 3

mild < 25 mmHg
moderate 25 - 40
severe 40 - 50
critical > 50

Question 4

What patient’s require bacterial endocarditis PPX?

Answer 4

1) prosthetic cardiac valve or prosthetic material used for valve repair
2) prior infectious endocarditis
3) unrepaired cyanotic congenital heart disease
4) 6mo post-op period following a repaired congenital heart defect using prosthetic material or a device
5) repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or device
6) cardiac transplant recipients who develop cardiac valvopathy

Question 5

Heparin 5000SQH: time to hold before epidural, when to restart after epidural

Answer 5

wait 4-6hrs for placement

can restart immediately, takes 2hrs for drug effect

Question 6

Heparin gtt: time to hold before epidural, when to restart after epidural

Answer 6

wait 2-4hrs after stopping

delay starting for 1hr after placement

Question 7

LMWH: time to hold before epidural, when to restart after epidural

Answer 7

low dose lovenox 40mg
delay for 12hrs following low dose

high dose lovenox 1mg/kg BID
delay 24hrs for high dose

Question 8

Abciximab: time to hold before epidural, when to restart after epidural

Answer 8

delay for 1-2 days

Question 9

Apixaban: time to hold before epidural, when to restart after epidural

Answer 9

delay for 72hrs (longer with renal impairment)

wait to restart until 6hrs after

Question 10

How much does atrial kick contribute to cardiac output in normal patient? Pt with aortic stensois?

Answer 10

normal 20%

AS 30 - 40% due to decreased compliance of the left ventricle

Question 11

What causes concentric ventricular hypertrophy?

Answer 11

results from pressure overload
sarcomeres are added in paralleled (thickening rather than lengthening)
ventricular volume is not increased

Question 12

What causes eccentric ventricular hypertrophy?

Answer 12

results from volume overload
sarcomeres are added in series (lengthening rather than thickening)
ventricular volume is increased

Question 13

how long do you postpone elective surgery for angioplasty, BMS, DES?

Answer 13

angioplasty - 14 days
BMS - 1 month
DES - 6 months (can do 3mo if risk of delaying surgery more than risk of stent thrombosis). Continue plavix for 1 year after.