Pulmonic, Tricuspid, Prosthetic valves

Question 1

Are mild and moderate PR “normal variants?”

Answer 1

Yes

Question 2

3 causes of severe PR

Answer 2

Carcinoid
TOF
Endocarditis

Question 3

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

Answer 3

Steep (may end abruptly)

Question 4

Most common etiology of Tricuspid Stenosis

Answer 4

Rheumatic

Question 5

JVP in TS

Answer 5

Giant a- wave

Diminished y descent

Question 6

What vena contracta is considered severe for all valvular regurge?

Answer 6

> .7cm

Question 7

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

Answer 7

C

Question 8

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

Answer 8

D

Question 9

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

Answer 9

Dense

Triangular with early peak

Question 10

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

Answer 10

At time of left sided valve Sx

Question 11

Is pressure half time in severe MS long or short?

Answer 11

Long

Question 12

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

Answer 12

Short

Question 13

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

Answer 13

Carcinoid

50%

Question 14

Test for carcinoid

Answer 14

24h urine 5-HIAA

Question 15

What valve lesion commonly occurs with carcinoid?

Answer 15

TS

Question 16

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

Answer 16

Ergotamine

Question 17

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

Answer 17

AR, MR

Question 18

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

Answer 18

Coxiella burnetti

Question 19

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

Answer 19

New regurgitation
New partial prosthetic valve dehiscence
Abscess

Question 20

Typical organisms causing endocarditis

Answer 20

Staph aureus
Strep viridans
Strep G, A, C
enterococcus

Question 21

Which resistant organisms require early surgery for endocarditis?

Answer 21

Staph aureus

Fungi

Question 22

What is considered a large vegetation on echo?

Answer 22

> 1cm

Question 23

Name 4 reasons in endocarditis to do early Sx

Answer 23

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

Question 24

Abx regimen for endocarditis ppx

Answer 24

Amoxicillin 2g

Cephalosporins or clinda if allergy

Question 25

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

Answer 25

Mechanical

Question 26

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

Answer 26

Bio

Question 27

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

Answer 27

q 3-6 mo's

Question 28

What are 3 risk factors for thrombosis of prosthetic valve?

Answer 28

AF previous thromboembolic event Low EF

Question 29

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

Answer 29

ASA 81

Question 30

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

Answer 30

Coumadin

Question 31

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

Answer 31

2-3

Question 32

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

Answer 32

Inc goal to 3.5-4.5

Question 33

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

Answer 33

Mechanical AVR

Question 34

Who usually gets patient-prosthesis mismatch?

Answer 34

Older women (LOL)

Question 35

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

Answer 35

TV

Question 36

Which prosthetic valves do better with thrombolytics?

Answer 36

Right sided valves

Question 37

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

Answer 37

Recent onset , NYHA class I-II sxs, small thrombus

Question 38

What prosthetic valve is at greatest risk of endocarditis?

Answer 38

MVR

Question 39

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

Answer 39

First 6 months

Question 40

Vmax and peak instantaneous gradient associated with severe PS

Answer 40

Vmax> 4 | PIG> 64 mmHg