Infective endocarditis

Pathogn- S.aureus, Group D streptococcus, Viridians, Enterococcus, Pseudomonas/Serratia(drug injection), HACEK group(Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) Duke criteria- 2 Major/1 Major+3 minor/5 minor *Prosthetic valve- Post-op<12 months(Coagulase negative staphylococcus), Post-op>12 months (Streptococci) *Injection drug- Right(S.aureus, pseudomonas), Left(Enterococci) High risk group- AS, congenital bicuspid, congenital heart(PDA, VSD, TF, coarctation) Dentistry surgery(For high risk) 1.Prosthetic heart valve 2.Previous […]

Aortic regurgitation

PE- valvular AR(left 3rd intercostal space), root dilation(right 3rd intercostal space) Acute Etiology-  IE, trauma, ascending aortic dissection, syphilis Presentation- Arterial pulsus alternans, Austin-Flint murmur, murmur at the right sternal border(for aortic dissection) Treatment- dobutamine, dopamine, sodium nitroprusside, digoxin, (avoid beta blocker) Chronic Etiology- bicuspid valve, Certain weight loss medications, such as fenfluramine and dexfenfluramine, […]

Aortic stenosis

Etiology: calcification, bicuspid valve, rheumatic fever Normal size: 3~4cm Severity- 1.5~3(mild), 1~1.5(moderate), <1(severe) Presentation- Angina(5), syncope(3), failure(2) PE: pulsus parvus et tardus, Harsh crescendo-decrescendo murmur Medication- B-blocker, CCB, diuresis, digoxin Surgery indication 1.AVA<1, Vmax>4, mean gradient>40 2.Asymptomatic+EF<50 3.Symptomatic Surgery: TAVI, Percutaneous balloon valvuloplasty, Ross procedure

Mitral regurgitation

Acute- posteromedial papillary muscle rupture→ nitropusside, IABP Chronic 1.Organic Etiology: myxomatous degeneration, rheumatic fever, IE Medication: ACEi, b-blocker Surgery: Asymptomatic severe MR+EF<60 or ESD>40, symptomatic+EF>30 or ESD<55 Other treatment- mitral clip 2.Functional Etiology: DCM, LV dysfunction Medication: ACEi, b-blocker Other treatment- mitral clip

Mitral stenosis

Etiology: Rheumatic fever, SLE, RA, calcification, IE Normal size: 4~6cm2 Severity- <1.5mm(moderate), <1mm(severe) PE– Opening snap, S1 increased, rumbling murmur Treatment: non-DHP, b-blocker, diuresis, prevent thrombus for AF PMBV: MVA<1.5 Surgery a)Indication- embolization, IE, pulmonary hypertension, moderate to severe MR, echo mitral valve score>8, PASA>60mmhg b)Balloon mitral valvuloplasty, open surgical mitral valvuloplasty, mitral valve replacement