Valve disease + aortopathy + pericardial

Question 1

valve option <50Y

Answer 1

mechanical

Question 2

valve option >65

Answer 2

bioprosthetic

Question 3

valve 50-60 ?

Answer 3

individualized decision making

Question 4

MR, TR medical therapy ? what’s not recommended ?

Answer 4

• treat as HF
• vasodilator therapy for asymptomatic primary MR and normal LV function

Question 5

sx of AS

Answer 5

• Angina
• syncope
• HF

Question 6

AS : afterload or preload dependent ? caution wth which meds ?

Answer 6

• afterload dependent
• VD/afterload reducers ( i.e. ACEI)

Question 7

Severe AS criteria

Answer 7

– Mean Gradient ≥40 mmHg
– Max jet velocity ≥4 m/s
– AVA <1.0 cm2

Question 8

etiologies of low flow low gradient AS with low EF
-sx

Answer 8

LV diastolic dysfunction
LV hypertrophy
LVEF <50%
- angina, hf, syncope

Question 9

text for low flow low gradient AS with low EF

Answer 9

Dobutamine stress echo or calcium score of the valve

Question 10

low flow low gradient AS with normal EF ( paradoxical low flow low gradient) . why? sx

Answer 10

LV wall thickness and small LV chamber with low stroke volume
restrictive diastolic filling
so your EF seems normal

SX: HF, angina, syncope

Question 11

low flow low gradient AS with normal EF ( paradoxical low flow low gradient) . why paradoxe

Answer 11

bcs ef N , but stroke is low but the EF is normal

Question 12

paradoxical low flow low gradient text ? values

Answer 12

• calcium scoring of the valve
• > 2000 ( men ) and >1300 *( women)

Question 13

AS indications for replacement ( Class 1 )

Answer 13

Severe, symptomatic AS

Severe, asymptomatic AS with LV dysfunction (LVEF <50%)

Severe, asymptomatic AS undergoing other CV surgery
AHA 2020 Valve

Symptomatic low-flow, low gradient AS with LV dysfunction (LVEF<50%)

Symptomatic low-flow, low gradient AS with LVEF >50% (“paradoxical” low- flow, low-gradient aortic stenosis)
T if AS most likely cause of symptoms

Question 14

TAVI/TAVR indications

Answer 14

• > 80
  -<10 y
• 50-65 : could consider
• intermediate/high/ prohib surgical risk

Question 15

TAVI contraindicated ?

Answer 15

if comorbidiites preclude benefits

Question 16

what increase in aortic velocity value will prompt you to reasonibly replacement ( class 2a)

Answer 16

velocity 0.3 m/s or more per year

Question 17

if patient is asymptomatic, but have critical AS , what’s critical value velocity ?

Answer 17

> 5 m/s

Question 18

EF% for Class indication in AR?

Answer 18

55%

Question 19

Etiology of MS most often ? associated with what often

Answer 19

rheumatic
afib

Question 20

MS does not like high HR , why?

Answer 20

loss of diastolic filling time

Question 21

MS does not like AF

Answer 21

loss of atrial kick

Question 22

CI to PMBC

Answer 22

1. moderate MR - can make it worse
2. LA thrombus

Question 23

in primary MR, what’s the goal of therapy ?

Answer 23

-correct MR before LV systolic dysfunction

Question 24

Class 1 MR

Answer 24

1. Severe, symptomatic primary MR irrespective of EF
2. Severe, asymptomatic , LV systoluc dysfunction ( EF <60%, LV ESD >40mm)

Question 25

reasonable class 2 A - asymptomatic , severe MR, EF >60%, LVESD >40.. what can they get ?

Answer 25

mitral valve repair with 95% success and <1% mortality at a comprehensive valve centre

Question 26

class II a for primary MR with high or prohibitive surgical risk can undergo which procedure if favorable anatomy and life expectancy greater than 1 year

Answer 26

transcatheter edge to edge repair

Question 27

class 1 indication for sx/intervention for secondary MR ?

Answer 27

none

Question 28

what is the treatment of 2nd MR

Answer 28

1. Max GDMT 2. CRT before consideration for PMVR aka mitaclip ijn pts wth HFrEF and severe FMR

Question 29

what's the class 1 indication for TR surgery ?

Answer 29

patient undergoing left sdied valve surgery

Question 30

trilluminate trial about TR

Answer 30

triclip was assocaited wth reduced TR and sx compared with medical therapy alone - no difference in mortality or HF hospit

Question 31

AVR INR

Answer 31

2-3

Question 32

INR 2.5-3.5 for ?

Answer 32

for any MVR or old AVR (ball-in-cage) or AVR with risk factors (RF = AF, prior clot, LV dysfxn, hypercoagulable state)

Question 33

ON-X aortic valve tx and target inr

Answer 33

INR 1.5-2 warfarin + low dose ASA

Question 34

bioprostetic valve tx

Answer 34

ASA lifelong

Question 35

bioprosthetic valve ( within 3M) + AF

Answer 35

VKA

Question 36

TAVI bioprosthetic valve post installation tx initial 3-6M

Answer 36

- DAPT - VKA ( low risk bleed)

Question 37

HOCM most common phenotype

Answer 37

asymmetric septal hypertrophy

Question 38

AF +HCM tx ?

Answer 38

OAC

Question 39

AF + HCM : chads applies ?

Answer 39

NOOOO

Question 40

ICD indication in HOCM - class 1 - class 2a - CLass 2b

Answer 40

- VA/ SCD - fam hx SCD, LV wall > 30mm, syncope, apical aneurysm, EF <50% - LGE on MRI or NSVT on hotelde

Question 41

HOCM is associated w/

Answer 41

- SAM MV --> MR - LVOTO ( dynamic ) - pap msc abN

Question 42

what do you want to avoid HOCM

Answer 42

dehydration Diuretics VD

Question 43

1st line med tx HOCM 2nd line med refractory. ?

Answer 43

- BB/CCB - cardiomyosin inhib ( disopyramide/mavacamten ) - septal myotomy/etoh ablation

Question 44

afterload reducing agents to avod in HCM preload reducing agents to avoid in HCM

Answer 44

acei nitrate, diuertics

Question 45

cardiac amyloidosis presentation

Answer 45

1. restrictive cdmp 2. hfpef 3. syncope 4. atrial arrythmia 5. bradyarrythmia 6. AS

Question 46

associated extracardiac manifestation of amyloidosis cardiac

Answer 46

- Autonomic dysfunction – Orthostatic hypotension – Gastroparesis – Sweating abnormalities – Neuropathy – Carpel tunnel syndrome – Renal insufficiency/Nephrotic syndrome – Sexual dysfunction

Question 47

mainstay tx of cardiac amyloidosis

Answer 47

diuretics

Question 48

cardiac amyloidosis : meds to avoid

Answer 48

- bb/ccb ( reduce CO , esp since restrictive) -acei/arb ( worsen dysautonomia, orthostasis ) - digoxin ( reduces inotropy)

Question 49

#1 RF for thoracic aortic dissection

Answer 49

htn

Question 50

other rf for thoracic aortic dissection

Answer 50

- vasculitis - valve disease ( bicuspid AV) - cocaine - marfan, ehler danlos

Question 51

best exam for thoracic aortic disease

Answer 51

CT

Question 52

thoracic aortic dissection med options

Answer 52

1. BB/CCB 2. VD ( nitrporusside , ACEI)

Question 53

what do you want to control first in thoracic aortic disease and why

Answer 53

HR , not BP bcs if hr high (or even as a compensatory mechanism) --> ++ sheer stress

Question 54

which thoracic aortic dissect requires urgent surg inter?

Answer 54

type a

Question 55

good IV meds for thoraci aortic dissection

Answer 55

IV labetalol

Question 56

if <50 , what test first test for thoracic aortopathy / aortic aneurysm

Answer 56

MRI

Question 57

serial echo timing in thoracic aorto/aortic aneurysm in loeys-Dietz and Marfan

Answer 57

yearly

Question 58

serial echo timing in thoracic aorto/aortic aneurysm in bicuspid AO valve aortopathy or degenerative

Answer 58

q1-3y

Question 59

bp meds in marfan thresholds ?

Answer 59

BB/losartan regardless if pt has htn

Question 60

BP target in thoracic aortopathy/aortic aneurysm

Answer 60

target BP <140/90

Question 61

fluoroquinolone in aortopathy may increase what ?

Answer 61

aneurysm rupture

Question 62

loeys dietz aorta size for operative management

Answer 62

4.5

Question 63

in AAA + asympto, medical therapy proven to reduce risk of rupture ?

Answer 63

smoking cessation

Question 64

surveillance recommendation in AAA - q3y who ? - q1y who ? - q6m who

Answer 64

- 3-3.9cm - 4-4.9 (M) & 4-4.5(F) - >5 (M), >4.5 women

Question 65

threshold surgery AAA

Answer 65

- men : >5.5 , women >5 - rate of growth >0.5cm/6 months

Question 66

AAA screening. for who

Answer 66

>65-80 , MEN, US x 1 ever

Question 67

if AAA + atherosclerotic disease present, what can you give ?

Answer 67

low dose AS

Question 68

pregnancy vs acute percarditis - <20 weeks - > 20 weeks -bf ok for colchicine ?

Answer 68

- ASA >nsaid , tylenol, pred - tylenol pred - avoid ASA NOOO

Question 69

if nsaid allergy and want to tx acute pericarditis - pred or colchi ?

Answer 69

colchi

Question 70

constriction pericardial signs - y acting how - kusmaul ? - pulsus ? - other

Answer 70

rapid y descent kussmauk sign no pulsus paradosis no

Question 71

temponade pericardial signs - y acting how - kusmaul ? - pulsus ? - other

Answer 71

- blunted Y descent on jvp - no - yes - beck's triad

Question 72

what's beck triad ?

Answer 72

hypoTA distended JVP muffled heart sounds

Question 73

which pericarditis has - ventricular interdependence - no ventricular interdependence

Answer 73

- constriction/tamponade - restriction

Question 74

in which disease we see restrictive cmp and ressemble which pathophysio and what's the difference with that entity

Answer 74

- syst disease (sarcoidosis, amyloidosis) - constrictive pericarditis - ventricular interdependence