Step 2 Flashcards
(37 cards)
most common cause of mitral regurgitation post MI
posteriomedial papillary muscle rupture after a posterior descending coronary artery MI due to its singular blood supply
most accurate test for diagnosing valvular heart disease
cardiac catheterization
indications for valve replacement in aortic stenosis
severe stenosis with symptoms
LVEF < 50%
other planned cardiac surgery
what indicates severe aortic stenosis
aortic pressure gradient >40mmHg, 0.7-1cm, velocity >4ms
treatment for acute vs chronic aortic regurgitation
acute AR: emergency replacement
chronic AR: vasodilators to decrease afterload and serial TEE to assess severity and need for surgery
management for mitral stenosis
diuretics for overload
BB, CCB, digoxin for rate control
Warfarin if associated valvular AF
definitive tx is replacement or catheter balloon valvuloplasty which is only reserved for symptomatic severe mitral stenosis due to rheumatic heart disease
treatment for first degree vs second degree mitral regurgitation
first degree: reassurance
second degree:
- acute = emergency replacement
- chronic = vasodilators to decrease after load. warfarin/BB if AF
if due to rheumatic fever;
- severe = clipping valve > replacement
management of tricuspid regurgitation
treat underlying cause
diuretics for overload
surgical replacement if severe + symptomatic without pulmonary HTN
aetiology of ascending vs descending aortic aneurysms
ascending think cystic medial necrosis or connective tissue
descending think atherosclerosis
screening of AAA
all men 65-75 years with history of smoking are recommended for once off USS screening for AAA
what is defined as a rapidly expanding aortic aneurysm
> 5mm increase in 6 months or >10mm in 12 months
70yr male patient presents abdominal pain and pulsatile abdominal mass. he is haemodynamically stable. best next investigation ?
CT abdomen
70 year old male patient presnts with abdominal pain and pulsatile mass. his BP is 60/30. ?next step
if history of AAA then emergency endovascular or surgical repair
if no history of AAA then USS abdomen
most important risk factor for aortic dissection
hypertension
best initial test for suspected aortic dissection ?
haemodynamically stable - CT angiogram (MR angiogram if contrast contraindicated)
haemodynamically unstable - transesophageal echo (TEE)
best initial management of aortic dissection
control heart rate and blood pressure with IV betablocker
definitive treatment for aortic dissection
stanford type A (ascending +/or decsending) = emergency surgical repair
stanford type B (descending only);
- signs of ischaemia = surgery
- no signs of ischaemia = medical management
what is defined as stanford type A aortic dissection
dissection proximal to left subclavian artery
what HR and BP are you aiming for in the medical management of oartic dissection
BP between 100-120
HR < 60bpm
Homans sign
calf tenderness with passive dorsiflexion of the foot
(poor sensitivity and specificity for DVT)
duration of anticoagulants in a patient who has an unprovoked DVT
if first DVT then 3 months
if >1 DVT then indefinitive
what is postphlebitic syndrome and how can it be prevented
post phlebitic syndrome is chronic venous insufficiency that develops after a DVT. Can develop severe symptoms affecting quality of life.
catheter-directed thrombolysis as an adjunct to anticoagulation in those with low bleeding risk
60 year old patient attended primary care doctor with heaviness in her legg, skin pigmentation and swelling. She had a DVT in the same leg 1 month ago and is currently on LMWH for it. ?diagnosis
post phlebitic syndrome
chronic venous insufficiency which can develop after DVT due to venous hypertension leading to thrombotic obstruction and reflux
treat with exercise, copression stockings and skin care
treatment options for post phlebitic syndrome
1st line (conservative): exercise, compression stockings, skin care to reduce eczema
2nd line (if acute clot): endovascular catheter-directed thrombolysis, stenting or surgical correction of venous reflux
