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CC July 2015 Valvular Heart Disease

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echoecho's version from 2015-10-30 13:02

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Question Answer
Despite the decline of what medical condition, the prevalence of valvular heart disease (VHD) is rising in the aging population of the US?rheumatic fever
Rheumatic fever / heart disease remains a major public health burden in developing countries in what age group?young adults
What role do providers play in patients who presents with asymptomatic heart murmur, VHD symptoms or incidental findings during other testing?1) early detection 2) early evaluation 3) early treatment 4) timely referral
*** Why should clinicians obtain a detailed history of cardiopulmonary symptoms, daily living activities and past history of rehumatic fever?because decisions about intervention depend on 1) presence or absence of symptoms 2) the severity of VHD 3) the respons of the left and/or right ventricle to the volume or pressure overload caused by VHD 4) the effect on the pulmonary and systemic circulation 5) a change of heart rhythm
List the 5 valvular lesions of common murmurs?1) aortic stenosis 2) aortic regurgitation 3) mitral stenosis 4) mitral regurgitation 5) mitral valve prolapse
State the type of murmur and the characteristics of the S1 and S2 for aortic stenosis?1) mid to late systolic, may be soft or absent if severe 2) S1 is normal 3) S2 is single or paradoxically split
State the type of murmur and the characteristics of the S1 and S2 for aortic regurgitation?1) blowing diastolic 2) S1 is soft 3) S2 is normal
State the type of murmur and the characteristics of the S1 and S2 for mitral stenosis?1) diastolic rumble 2) S1 is loud 3) S2 is normal
State the type of murmur and the characteristics of the S1 and S2 for mitral regurgitation?1) holosytolic 2) S1 is soft 3) S2 is normal or split
State the type of murmur and the characteristics of the S1 and S2 for mitral valve prolapse?1) mid to late systole (crescendo-decrescendo) 2) S1 is normal 3)S2 is normal
*** New VHD guidelines published in 2014 proposes the classification of VHD as to severity and progression into four stages (A-D), define each stage?Stages of progression of VHD = 1) stage A (at risk; no evidence of VHD) 2) stage B (progressive; asymptomatic mild to moderate VHD) 3) stage C (asymptomatic severe VHD = C1 is left or right ventricle remains compensated; C2 = decompensated left or right ventricle) 4) stage D = symptomatic severe VHD
*** The updated guidelines recommend what procedure for initial evlauation of patients with known or suspected VHD?TTE (transthoracic echocardiogram)
TTE is helpful in areas, name these?1) confirming diagnosis of VHD 2) assessing the severity and hemodynamic consequences 3) determining etiology and prognosis 4) recommending the time of surgical intervention
Clinicians may repeat TTE in what patients?1) those with known VHD who develop new symptoms OR 2) those who have a change in symptoms or clinical findings
For asymptomatic patients, the guideline recommends periodic monitoring with TTE at intervals depending on what 4 criteria?1) valve lesion 2) severity 3) ventricular size 4) ventricular function
What is the frequency of echocardiogram in asymptomatic patients with VHD and normal LV function for stage B (progressive) and stage C (severe) for aortic stenosis? 1) stage B (progressive) = every 3-5 years for mildly severe and every 1-2 years for moderately severe 2) stage C (severe) = every 6-12 months when Vmax > 4 m/s
What is the frequency of echocardiogram in asymptomatic patients with VHD and normal LV function for stage B (progressive) and stage C (severe) for aortic regurgitation?1) stage B (progressive) = every 3-5 years for mildly severe and every 1-2 years for moderately severe 2) stage C (severe) every 6-12 months; more frequently if dilating left ventricle
What is the frequency of echocardiogram in asymptomatic patients with VHD and normal LV function for stage B (progressive) and stage C (severe) for mitral stenosis?1) stage B (progressive) = every 3-5 years for MVA > 1.5 cm2 2) stage C (severe) = every 1-2 years for MVA 1.0-1.5 cm2. Every year for MVA < 1.0 cm2
What is the frequency of echocardiogram in asymptomatic patients with VHD and normal LV function for stage B (progressive) and stage C (severe) for mitral regurgitation? 1) stage B (progressive) = every 3-5 years for mildly severe and every 1-2 years for moderately severe 2) stage C (severe) = every 6-12 months; more frequently if dilating left ventricle
What is MVA? What is Vmax?1) MVA is mitral valve area 2) Vmax is maximum velocity
What additional testing may be done for further evaulation when indicated?1) transesophageal echocardiogram (TEE) 2) stress testing 3) cardiac catherization 4) cardiac computed tomography (CCT) 5) cardiac magnetic resonance imaging (CMRI)
What does TEE provide in way of assessment?it provides more definitive assessment of valvular structures and prescnce of thrombus when the findings of TTE are suboptimal
What is exercise stress testing helpful in confirming?1) the absence of symptoms 2) the assessment of the hemodynamic response to exercise 3) in determining prognosis
Clinicians should be cognizant of the risks of performing cardiac stress tests on patients with severe valvular stenosis, true or false?true
*** Cardiac catherization with meticulous attention to hemdynamic measurements is recommended in what type of patients?symptomatic patients when findings of noninvasive tests and physical exam are INCONGRUENT with the severity of clinical symptoms
While evaluating patients with suspected VHD, clinicans should also screen and manage other cardiac risk factors (HTN, DM, hyperlipidemia). Blood pressure should not be abruptly lowered in patients with what VHD lesions?stenotic lesions
Does vasodilator therapy slow downt he progression of valvular heart disease?no
Acute rheumatic fever is caused by what infection? What is the long-term adverse effect?1) group A streptococcus infection 2) valvular disease
True of false? the valvular disease may not become appartent for decades following initial infection with rheumatic fever?true
Any patients who has had rheumatic fever is at risk for what?1) recurrence 2) progression of VHD from the first episode 3) new-onset VHD
What prophylaxis is recommended for all patients w/ a hx of rheumatic heart disease?antibiotic prophylaxis
Is episodic treatment with prophylatic antibiotic recommended for rheumatic fever patients? why or why not?1) no 2) rheumatic fever can occur with asymptomatic infection and with treated infection as well
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