CARDIOLOGY
VALVE REPLACEMENT
PromptPost valve replacement (deterioration) investigations + justify
ResponseCXR – identify other post op causes of dysponoea (pleural effusion, Pneumothorax)
ECG – identify arrhythmia, signs RV/LV strain (ie AF)
Hb – identify anaemia (common post op)
Renal Function – may have AKI from operation, new meds ie ACE-I
Coagulation profile – if on warfarin for mitral valve, will alter risk of valve thrombosis
ECG – identify arrhythmia, signs RV/LV strain (ie AF)
Hb – identify anaemia (common post op)
Renal Function – may have AKI from operation, new meds ie ACE-I
Coagulation profile – if on warfarin for mitral valve, will alter risk of valve thrombosis
PromptU/S findings - causes of dyspnoea post valve replacement
ResponseLV Failure – decreased LV function with pulmonary congestion (decreased EF, dilated LV, B lines, effusions)
Paravalvular leak with acute MR (dilated LA, dynamic LV) (transvalv colour jet (retrograde during systole, dilated LA, pulmonary congestion)
Valve Thrombosis with Left atrial dilation and poor LV filling (small hypodynamic LV with large LA and minimal colour flow across valve (may see thrombus at LV inlet region)
New AF – irregular LV activity with variable filling and ejection, tachycardia
Pericardial effusion – large effusion on USS +/- signs of impaired RA/RV filling
Pulmonary Embolus with acute RV dilation, bowing of IV septum, mcconnell’s sign or visible thrombus
Paravalvular leak with acute MR (dilated LA, dynamic LV) (transvalv colour jet (retrograde during systole, dilated LA, pulmonary congestion)
Valve Thrombosis with Left atrial dilation and poor LV filling (small hypodynamic LV with large LA and minimal colour flow across valve (may see thrombus at LV inlet region)
New AF – irregular LV activity with variable filling and ejection, tachycardia
Pericardial effusion – large effusion on USS +/- signs of impaired RA/RV filling
Pulmonary Embolus with acute RV dilation, bowing of IV septum, mcconnell’s sign or visible thrombus
PromptProsthetic valve thrombosis
ResponseLocation Mitral >aortic
Material - Bare metal > Tissue
Daily thrombosis risk <1% off anticoagulation
Material - Bare metal > Tissue
Daily thrombosis risk <1% off anticoagulation