Pulmonic, Tricuspid, Prosthetic valves Flashcards Preview

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Flashcards in Pulmonic, Tricuspid, Prosthetic valves Deck (40):
0

Vmax and peak instantaneous gradient associated with severe PS

Vmax> 4
PIG> 64 mmHg

1

Are mild and moderate PR "normal variants?"

Yes

2

3 causes of severe PR

Carcinoid
TOF
Endocarditis

3

In severe PR, where color jet fills RVOT, what will the CW deceleration slope look like?

Steep (may end abruptly)

4

Most common etiology of Tricuspid Stenosis

Rheumatic

5

JVP in TS

Giant a- wave
Diminished y descent

6

What vena contracta is considered severe for all valvular regurge?

>.7cm

7

What stage is severe, asxs TR (VC>.7cm, hepatic vein systolic flow reversal)?

C

8

What stage is severe sxs TR (vena contracta>.7cm, hepatic vein systolic reversal)?

D

9

What do CW jet density and contour look like in severe TR?

Dense
Triangular with early peak

10

When is TV repair a class I indication for severe TR?

At time of left sided valve Sx

11

Is pressure half time in severe MS long or short?

Long

12

Is pressure half time in severe AI long or short?1

Short

13

Sxs: flushing, diarrhea, wheezing. Dx? What percent of pt's develop cardiac involvement?

Carcinoid
50%

14

Test for carcinoid

24h urine 5-HIAA

15

What valve lesion commonly occurs with carcinoid?

TS

16

Migraine Rx similar to carcinoid except causes more left sided valve lesions

Ergotamine

17

What left sidd lesions do radiation and antiphospholipid Ab syndromes usually cause?

AR, MR

18

What bug requires only a single Cx to be considered a major criteria for endocarditis?

Coxiella burnetti

19

3 echo findings,besides veg, that count as major criteria for endocarditis

New regurgitation
New partial prosthetic valve dehiscence
Abscess

20

Typical organisms causing endocarditis

Staph aureus
Strep viridans
Strep G, A, C
enterococcus

21

Which resistant organisms require early surgery for endocarditis?

Staph aureus
Fungi

22

What is considered a large vegetation on echo?

>1cm

23

Name 4 reasons in endocarditis to do early Sx

Valve dysfxn/LV dysfxn
Resistant org (s. aureus, fungi)
Heart block/ abscess
Persistent infection
Increased LVEDP

24

Abx regimen for endocarditis ppx

Amoxicillin 2g
(Cephalosporins or clinda if allergy)

25

Under age 60, what type of prosthetic valve is recommended?

Mechanical

26

After age 70, what type of prosthetic valve is recommended?

Bio

27

If you detect regurgitation of a prosthetic valve, how often do you do followup echoes?

q 3-6 mo's

28

What are 3 risk factors for thrombosis of prosthetic valve?

AF
previous thromboembolic event
Low EF

29

All patients with a prosthetic valve (bio or mech) should get what med?

ASA 81

30

What anticoagulatuon or ASA do you do for a patient with a bio prosthetic valve and 1 risk factor?

Coumadin

31

What is INR goal for mech AVR and no risk factors?

2-3

32

What do you do if patient has a thromboembolic event with prosthetic valve when INR was 2.5-3.5?

Inc goal to 3.5-4.5

33

Which type of prosthetic valve does not require heparin or lovenox bridge for Sx?

Mechanical AVR

34

Who usually gets patient-prosthesis mismatch?

Older women (LOL)

35

Which type of prosthetic valve is at greatest risk for thrombosis?

TV

36

Which prosthetic valves do better with thrombolytics?

Right sided valves

37

According to prosthetic valve thrombosis guidelines, when is it ok to give fibrinolytics?

Recent onset , NYHA class I-II sxs, small thrombus <.8cm
FAILED heparin gtt

38

What prosthetic valve is at greatest risk of endocarditis?

MVR

39

When after a prosthetic valve placement, is the greatest risk of endocarditis?

First 6 months