Valve Disease

Question 0

Bicuspid incidence

Answer 0

1-2% general population
Majority never develop stenosis
Associated with coarctation

Question 1

Bicuspid aortic stenosis

Answer 1

Look for AI and aortic dissection

Question 2

Aortic stenosis

Answer 2

May be atherosclerotic
Severe stenosis late peaking with obscure s2
Pulses parvus tardus

Question 3

Valve area

Cardiac out put/ heart rate x SEP x 44.3x square root of the gradient

Answer 3

Hakki

Cardiac out put/ square root of the gradient

Question 4

Aortic stenosis

Answer 4

Mild velocity 1.5

Severe velocity >4m/sec gradient >40 valve area <1.0

Question 5

Severe a symptomatic AS

Answer 5

Stress test is reasonable

Question 6

AS follow up 
Change in symptoms 
Asymptomatic
Yearly for severe AS
Every 2 years got moderate AS
Every 5 for mild

Answer 6

Expect
Jet velocity increase 0.3 m/sec
Gradient increSe 7 mmhg/ year
Valve area decrease 0.1 cm per year

Question 7

AS symptoms and survival

Answer 7

Angina 5 years
Syncope 3 years
Failure 2 years

Question 8

Low flow low gradient

Answer 8

10% cases
Dibutamine echo
Low flow Gorlin formula is wrong
Pseudo stenosis due to after load mismatch

Question 9

Treatment of AS

Answer 9

Statin no benifit by saltire trial

Acei poss effect on inflammation

Question 10

AVR

Answer 10

2-4% mortality in low risk

15-20% in high risk

Question 11

TAVR indications

Answer 11

Severe AS
STS greater than 8%
Inoperable high risk
Life expectancy greater than 1 year

Question 12

Bicuspid and aortic root

Answer 12

Replace aorta greater than 5.5 cm
Greater than 5 for rapid progression
Aorta greater than 4.5 with severe AS

Question 13

AI severity

Answer 13

Vena contracts 0.6
Pressure half time mild >450 severe central jet width 65%,flow reversal > 0.6m/sec, Regurgitant volume >60ml, Regurgitant fraction > 55% EROA 0.3
Pressure half time 200 vena contracts >0.6 cm2

Question 14

Acute AI

Answer 14

Tachycardia
Pulm edema
Short murmur
Diastolic MR

No IABP use nipride

Question 15

AI presentation

Answer 15

Dyspnea

Angina due to decreased reserve

Question 16

AI low EF

Answer 16

Need AVR

Question 17

AI symptoms

Answer 17

Symptoms 25% a year

After symptoms death 10% a year

Question 18

Chronic AI

Answer 18

Nifedipine and acei class 1

Question 19

AI operative mortality

Answer 19

EF >50% 3.7%
35%. 6.7%
<35% 14%

Question 20

AI indication for surgery

Answer 20

Symptoms
LV dysfunction 50
EDD>70(2b)
LVESD>55

Question 21

MS

Answer 21

Evaluate for afib

Question 22

MS severity

Answer 22

Mild gradient 1.5

Severe gradient >10 PAP >50 area <1.0

Question 23

MS

Answer 23

OS

Loud S1

Question 24

Survival of MS

Answer 24

No symptoms 10 year survival 80-100% Limiting symptoms 10 year 0-15% Pulm HTN < 3 years

Question 25

MR severe

Answer 25

``` Jet area >0.5 Regurgitant volume >60 Regurgitant fraction >55% Vena contracts >0.7 cm ERO >0.4 Normal LA the MR is not severe ```

Question 26

MR types

Answer 26

Type 1 dilated root Type 2 prolapse Type 3 pap dysfunction 3b ischemic

Question 27

Increase MR

Answer 27

DecreAse survival Increase CV events LV gram is still gold standard

Question 28

Moderate MR

Answer 28

Annual echo

Question 29

Indication for mitral surgery

Answer 29

EF >30% ESD 55 if chordal preservation likely, medical therapy if chordate can't be preserved Severe MR EF < 60% or ESD >40 mm New onset afib or pulm HTN Do early before symptoms worsen

Question 30

MR

Answer 30

Repair if possible

Question 31

Pulm stenosis

Answer 31

``` Isolated Tetralogy Rubella Carcinoid Gradient >4m/sec Treatment valvuloplasty ```

Question 32

Pulm regurgitation

Answer 32

``` Carcinoid Tetralogy Endocarditis RV overload Bio prosthetic ```

Question 33

TRicuspid stenosis

Answer 33

``` Rheumatic Carcinoid Congenital Fabry Drugs ergot Valve area 1 cm2 balloon or bio prosthetic ```

Question 34

TR

Answer 34

``` Pulm HTN Cardiomyopathy Left sided valve disease Rheumatic Ebstein Radiation ```

Question 35

Surgery severe TR

Answer 35

Severe TR in peopke undergoing left sided valve surgery Less than severe TR with left sided valve surgery if there is pulm HTN Severe TR with symptoms Primary TR with RV failure

Question 36

MS and AI

Answer 36

Pressure half time of MS will be long and pressure half time of AI will be short

Question 37

Carcinoid

Answer 37

``` Primary GI Cardiac involvement 50% Check 24 hour urine 5-HIAA Octreo scan Ergot Diet drugs ```

Question 38

Radiation effects

Answer 38

10-15 years after radiation Coronaries valves and pericardium Concomitant chemo MR and AI

Question 39

Antiphospholipid antibody

Answer 39

Superficial thrombosis Non bacterial endo Regurgitation MR AI

Question 40

Endocarditis

Answer 40

Blood cultures single for coxiella Evidence if vegetation Echo evidence

Question 41

Endocarditis

Answer 41

DX 2major 1 major 3 minor 5 minor

Question 42

Prophylaxis

Answer 42

``` Prosthetic valves Prior endo Unrepaired cyanotic congenital Repaired with residual Transplant with Regurgitant lesions ```

Question 43

Bio prosthetic after 70

Answer 43

``` Routine yearly echo class 2b Regurgitation detected every 3/6 mos ```

Question 44

Mechanical valves and Coumadin

Answer 44

Stroke untreated 4-8% a year Treated 1-2% year Bio prosthesis 1-2% a year

Question 45

Anticoag guide lines

Answer 45

Afib Previous CVA Hypercoagulable state EF <30%

Question 46

Asa 75 all mechanical and bio

Answer 46

INR 2-3 mechanical AVR and 3 MIs for bio INR 2.5-3.5 for the rest

Question 47

Short term interruption of Coumadin

Answer 47

``` Bi leaflet AVR no bridge Bridge all the rest with UFH Lmwh is ok now FFP urgent cases No vit K ```

Question 48

Bio prosthetic

Answer 48

20-30% dysfunction in 10 yrs 50% by 15 years Increase in young pregnancy and RF Look for patient valve mismatch

Question 49

Valve thrombosis | 2% per year

Answer 49

``` Thrombolysis effective 70-90% More on the right sided Mortality 4-12 % with lysis Surgery for large clot class 3-4 Small clot class 1-2 consider lysis ```

Question 50

Endocarditis

Answer 50

Mitral more common 0.5% even with antibiotics Stable endo no surgery needed Hemolysis may need to be replaced

Question 51

AS surgery

Answer 51

Symptomatic EF less than 50% no symptoms Worsening gradient Abnormal stress test

Question 52

MS

Answer 52

Symptomatic survivsl 50% | Valvuloplasties symptomatic or asymptomatic with moderate to severe disease with pulm HTN

Question 53

Tricuspid stenosis

Answer 53

Gradient 7mm hg area 1 cm2

Question 54

TR severity

Answer 54

Jet width 0.7 Pisa 0.9 Vena contracta >0.7 Central jet >10cm2