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12 Cards in this Set
- Front
- Back
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When is TTE indicated when a murmur is heard? |
- Systolic murmurs > grade 3/6 or late or holosystolic murmurs - Diastolic or continuous murmurs - Murmurs w/ accompanying symptoms |
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When is TEE indicated? |
Assessment of leaflet involvement, particularly for patients w/ MR |
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For evaluation of AS, what is contractile reserve? |
- An increase in transaortic stroke volume of > 20% with dobutamine infusion - In patients w/ severe AS w/ LV dysfucntion but reserve, mean gradient will increase w/ dobutamine stress, AV area will remain below 1.0cm, these patients will benefit from AVR. - Those w/ an increase in AVR to greater than 1cm w/ max velocity < 4 and mod AS --> medical therapy - Contractile reserve - if not present portends to worse prognosis w/ surgery |
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What is paradoxi low gradient AS? |
AV is reduced in setting of preserved EF but reduced SV, associated w/ small LV size and LVH - This may cause the severity of stenosis to be understimated by echo due to low gradient - Surgical candidate |
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How is AS managed? |
- Exercise stress to see whose symptoamtic --> predictive of more rapid progression - AVR is indicated in symptomatic patients, and asymptoatic patients w/ severe disease and LV dysfunction - AVR associated w/ low mortality, valvuloplasty has a limited role, typically effect lasts a couple months |
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When is TAVR indicated? What are the results of the PARTNER trial? |
- Higher risk patients, have similar survival to surgical replacement; - TAVR is superior to medicla therapy in patietns thoguth not to be surgical candidates - Not approved for patients with bicuspid valves, significant AR, or mitral valve disease - Patients who have an STS score > 8 (surgical risk) |
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How is AR managed? |
Acute AR Chronic severe AR - in symptomatic patients, or in patients w/ AV dysunfction, and those undergoing CABG - If there is an associated aortic root aneurysm, combined AVR - Before proceeding to surgery, can mediate w/ vasodilators and inotropic agents - Medications including ACEs, ARBs, calcium channel blockers have not been shown to delay need for surgery |
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How often should patients be screened for bicsupid valve? |
Asymkptomatic patients w/ bicuspid AV and severe AVS require yearly echo Those with midl stenosis - TTE every 3- 5 years - If there is ascending aortic dilation of 4.5 or greater, should have yearly TTE --> surgery is indicated when the aortic root diameter is > 5.5cm, or if > 5 and there is a hx of dissection in the family - First degree relatives of patients w/ a bicuspid AV is indicated |
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When do patients typically develop symptoms in MV stenosis? |
When valve area is < 1.5cm |
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When is MVR indicated? |
NYHA II, III or IV with severe mitral stenosis and favorable valve morphology - as evaluated by TTE, TEE (better eval of regurgitant severeity and LA thrombus), multidetector CT - Contraindications include LA appendage or clot, or significant MR - MV surgery is indicated in patients w/ NYHA fucntional class II/IV when valvuloplasty is unsuccessful or contrainducated, or valve morphology is unfoavrable |
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What is the medical management of MR? |
Diuretics Long acting nitrates, can improve dyspnea - BB and NHCB can lower HR and improve filling time |
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What can cause MR? |
- Abnormality in any of the structures of the mitral valve, including anterior and posterior leaflets, annulus, and papillary muscles, and chordae tendinae |
