Do you hear what I hear?
This murmur is associated with AS (name the phase of cardiac cycle and the sound)
mid-systolic crescendo-decrescendo
True or false: Medical therapy has been shown to prevent disease valvular heart disease (VHD) progression and improve long-term survival in patients with VHD
False. Medical therapy merely improve symptoms
What age group is a mechanical valve appropriate for?
What age group is a bioprosthetic valve appropriate for?
1. <50
2. >65
What is the classic triad of symptoms associated with severe AS?
Syncope
Angina
Dyspnea
What is the most common symptom of any valvular disease?
Dyspnea on exertion
Have you heard? This is the leading cause of mitral stenosis...
Rheumatic heart disease
More prevalent in females
What anticoagulant is indicated in AFIB + mitral stenosis?
Warfarin
What are the indications (3) for open valve replacement in severe AS?
1. Presence of sx
2. LV dysfunction
3. Concomitant cardiac surgical procedure (CABG, TAA repair)
What is the congenital condition that can lead to AS?
Bicuspid aortic valve
What is the life expectancy of those with severe AS once symptoms arise?
1-2 years
Classic murmur associated with MS and what phase of the cardiac cycle?
Opening diastolic snap
What is the INR goal in those with AFIB + Mitral Stenosis?
2-3
Your echo findings don’t add up to your symptom severity for AS workup, what’s the next step in eval?
Cardiac catheterization
To distinguish between pseudo-severe AS from true
What is the definition of severe AS as defined on echo?
Small valve area (≤1.0 cm2), High peak velocity (>4 m/s), and/or high mean gradient (>40 mm Hg)
What is the leading cause of death in patients with MS?
Heart failure
What is the common murmur heard with mitral regurgitation and where is it heard?
1. Holosystolic blowing 2. Apex
INR goal in those with mechanical aortic valve?
2.5-3.5
When is TAVI preferred over SAVR? (Name 1 of 3)
1. Over 80 y.o
2. Life expectancy <10 years
3. High surgical risk
How does AS pathophysiologically present on echo in patients with severe LV dysfunction?
Low flow, low gradient
What percentage of patients with MS have AFIB?
50%
This valvular pathology is associate with a
decrescendo blowing murmur during diastole
Aortic regurgitation
What medication is indicated in patients with bioprosthetic valves?
Aspirin
Bioprosthetic valves are preferred in those who can't tolerate anticoagulation
What procedure is indicated in symptomatic severe rheumatic MS?
Percutaneous balloon mitral commissurotomy (PBMC)
What are the four steps in the physiological progression of AS?
1. Chronic pressure of LV
2. LVH
3. Diastolic dysfunction
4. Systolic Failure
What is your next step when your echo findings don’t match your severity of MS?
Exercise echo