Term
|
Definition
senile calcification
congenital bicuspid valve
rheumatic heart disease |
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Term
| what is the classic Triad for AS presentation? |
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Definition
|
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Term
|
Definition
ejection systolic click radiates to carotids
pulse is slow rising with narrow pulse pressure
apex beat: Heaving but NON displaced
there is a LV heave |
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Term
| what does having AS predispose you to? |
|
Definition
to Angina. This is why you should auscultate the heart in someone who presents with angina.
angina in 2/3 of pts with critical AS |
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Term
| what is the latin name for the slow rising flat pulse in AS? |
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Definition
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Term
| where is the murmur of AS best heard? |
|
Definition
| base of heart and 2nd RICS |
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Term
| what does a 4th heart sound indicate in AS indicate? |
|
Definition
| left ventricular hypertrophy and severe AS |
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Term
| what tests would you do in AS? |
|
Definition
ECG: look for P mitre, LVH, LBBB or complete AV block due to calcified ring
CXR: LVH, calcified aortic valve, post stenotic dilatation of ascending aorta
echo: diagnostic. |
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Term
| what gradient suggests severe AS? |
|
Definition
if peak gradient is > or equal to 50mmHg and valve area < 1cm squared.
Cardiac catheter can assess: valve gradient; LV function; coronary artery disease; but risks emboli. |
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Term
|
Definition
hypertrophic cardiomyopathy
MR
aortic sclerosis
pulmonary stenosis |
|
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Term
|
Definition
TAVI if pt not medically fit for surgery
AVR - in those with moderate/severe disease |
|
|
Term
| explain the TAVI procedure |
|
Definition
can be done under GA or LA with sedation
balloon valvuloplasty of aortic valve is first performed then the valve device is inserted
the procedure is done under fluoroscopy and echo guidance
the heart is paced at 200bpm to make the procedure easier |
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Term
|
Definition
| just as effective as surgical AVR |
|
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Term
|
Definition
major bleeding from entry sites
stroke/TIA - risk higher than for AVR
VT, MI, aortic dissection
cardiac tamponade
post op AR |
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Term
|
Definition
disease causes decompensation eventually leading to increased end diastolic pressure, increased pressure in pulmonary system and congestive heart failure.
damaged valves - risk for endocarditis
calcified AS may throw off small clots
sudden death occurs in <0.2% of pts |
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|
Term
|
Definition
co existing CAD
age
atherosclerosis
bad changes on echo suggest poor prognosis e.g. excessive LVH, valve calcification |
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Term
| if moderate/severe AS then mortality is high when rx medically. what is recommended in these pts? |
|
Definition
| prompt valve replacement. |
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|
Term
what am i?
i have an ejection systolic murmur, no radiation to carotids and my pulse is normal. |
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Definition
|
|
Term
|
Definition
rheumatic heart disease
degenrative
congenital parachute valve
SLE
infective endocarditis |
|
|
Term
|
Definition
SOB/fatigue
pulmonary oedema, hemoptysis
RHF is a late sign |
|
|
Term
|
Definition
mid diastolic rumble with opening snap
Tapping apex
AF
loud 1st HS
mitral facies |
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|
Term
| how can you excentuate the murmur of MS? |
|
Definition
Listen on the LHS with the pt in expiration using BELL
the murmur doesnt radiate |
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|
Term
| examination findings in MS? |
|
Definition
AF is common
pulmonary congestion |
|
|
Term
| what is Austin flint murmur associated with? |
|
Definition
|
|
Term
| Carey Coombs murmur what is it associated with? |
|
Definition
| Rheumatic fever and a DDx for mitral stenosis |
|
|
Term
|
Definition
• Malar flush on the cheeks
• Raised JVP
• Laterally displaced apex beat and RV heave
• Loud S1 and opening snap in early diastole
• mid-late diastolic murmur best heard with pt in left lateral position with bell
• AF
• Signs of RVF including hepatomegaly, ascites and peripheral edema |
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|
Term
| which is the diagnostic test in MStenosis? |
|
Definition
Echo
• Used to asses severity and consequences of MS
o Also tells us pulmonary artery pressures, if there is mitral regurg, other valve disease and size of LA
o As MS is frequently associated with other valve diseases, a comprehensive evaluation of tricuspid and aortic valves is essential |
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|
Term
|
Definition
• Asymptomatic pts with clinically significant MS and no intervention should have annual echo. In cases of less severe stenosis, follow up can be 2-3 yearly
• Percutaneous mitral valve commissurotomy (PMC) rx of choice when indicated. AKA valvulotomy – involves making one or > incisions at the edges of the commissure formed between the valves in order to relieve the constriction. |
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|
Term
| • Contraindications to PMC |
|
Definition
o Mitral valve area >1.5cm squared
o LA thrombus
o Severe or bicommissural calcification
o Severe concomitant aortic valve disease, combined tricuspid stenosis and regurg, concomitant CAD needing bypass |
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|
Term
| medical tx to rx dyspnoea in MS? |
|
Definition
| diuretics or long acting nitrates |
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|
Term
| medication to improve exercise tolerelence in MS? |
|
Definition
| • beta blockers or HR regulating ca channel blockers |
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|
Term
| apart from medication to relive SOB and improve exercise tolerance what other medical rx should someone with MS be on? |
|
Definition
| anticoagulation medication for AF |
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|
Term
| what surgical options are available in the mx of MS? |
|
Definition
• Sx valve replacement should be considered for pts who are not suitable for percutaneous intervention. Surgery is mostly valve replacement rather than valve repair. This is due to increasing elderly presentation and unfavorable valve characteristics for valve repair.
• Mitral valve sx and excision of the LA appendage may be considered in pts with severe MS who have had recurrent embolic events while receiving adequate anticoagulation |
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