0071643192.pdf

DIAGNOSIS

■ ECG: Nonspecific ST-T wave changes,paroxysmal supraventricular tachy-

cardia (PSVT)

■ CXR: No specific findings

■ Echo: Confirmatory

TREATMENT

■ No treatment if asymptomatic

■ Prophylaxis for endocarditis if regurgitation or thickened valve leaflets

■ β-Blockers may help with atypical chest pain.

COMPLICATIONS

■ Stroke

■ Endocarditis

■ Tachydysrhythmias (atrial and ventricular)

■ PSVT (most common dysrhythmia)

■ Increased incidence of WPW, PACs, PVCs

■ VT possible

■ Sudden death

■ Risk factors include syncope/near syncope, murmur, inferolateral ST-T

changes, PVCs

Tricuspid Regurgitation

CAUSES

The most common causes are right ventricular dilation (from pulmonary

HTN), endocarditis, and rheumatic heart disease.

SYMPTOMS

■ Fatigue

■ Dyspnea

■ Lower extremity swelling

EXAM

■ Holosystolic murmur at left lower sternal border

DIAGNOSIS

■ ECG: Right atrial and ventricular enlargement, atrial fibrillation (in the

majority of cases)

■ Echo is confirmatory.

TREATMENT

■ Treat atrial fibrillation.

■ Endocarditis prophylaxis

Prosthetic Valve Complications

Prosthetic heart valves may be mechanical or bioprosthetic (porcine or bovine).

Mechanical valves have a metallic sound on auscultation and require lifelong

anticoagulation. Complications include paravalvular leak, valve thrombosis,

endocarditis, and systemic embolization.

VALVEFAILURE

Ranges from gradually worsening paravalvular leak to abrupt mechanical

valve failure

CARDIOVASCULAR EMERGENCIES

Risk factors for sudden death

in MVP include syncope,

murmur on exam,

inferolateral ST-T changes,

and PVCs.