Please enable JavaScript.

Coggle requires JavaScript to display documents.

Valve Replacement (Viva Ix (Blood (FBC: anaemia – MAHA, bleeding, U+E:…

- - - - Valve regurgitation or stenosis
      - Peri-valvular leak
      - Vegetations
      - LV function
      - Other valve function
- - - - Audible valve click
      - Anticoagulation → bruising
      - Warfarin alert bracelet
      - Anaemia
    - - Midline sternotomy: CABG, AVR, MVR
      - Left lat. inf. thoracotomy: MVR, mitral valvotomy
      - Neck scars from line insertion
      - Groin / femoral scars from angiography
      - Vein harvesting scar on the medial leg
      - May have had CAGB too
    - - Variable
      - AF suggests mitral valve replacement due to MS
      - Time prosthetic clicks w/ pulse
        Occur in time = mitral valve
  - - - When and where is the closing prosthetic sound?
        
        Starr-Edwards: 3 artificial sounds
        
        Quieter click as valve opens
        
        Loud thud as valve closes
        
        Rumbling sound as ball rolls in cage
        
        Tilting disc or bileaflet: 1 artificial sound
        
        High-pitched click as valve closes
        
        Biological Valve
        
        Often normal heart sounds
        
        Aortic
        
        Lub-Click
        
        ± systolic flow murmur
        
        Abnormal: AR (EDM)
        
        Mitral
        
        Click-Dub
        
        ± diastolic flow murmur
        
        Abnormal: MR (PSM)
      - Are there any murmurs?
        
        Well-seated valves may have soft flow murmurs
        
        Aortic: systolic
        
        Mitral: diastolic
        
        Poorly-seated valves → regurgitation
        
        Aortic: diastolic
        
        Mitral: systolic
- - - - Early: Staph. epidermidis
        Late: Strep. viridans
        May require 2nd valve replacement
        Mortality: 60%
        NB. avoid erythromycin if on warfarin
    - - Failure
        
        Chronic: stenosis or incompetence
        
        Acute: dehiscence, breakage, thrombus