Things I learnt today from MRCP Part 2 revision (Day 1)

From the ESC  and some other places:

  1. Peripartum cardiomyopathy needs heparin (prophylactic dose if ejection faction > 30%, treatment dose if less than 30% or if AF or previous clot).
  2. Pencillin V is continued for 10 years since the last episode of rheumatic fever, or until 40, whichever is longer.
  3. In severe AS (valve < 1cm^2, gradient > 40mmHg), surgery is indicated if symptomatic or if LVEF < 50% with no other cause.
  4. In MR, symptoms, LVEF <60% or new AF are all indications for surgery, which should be valve repair ideally. Andsuper  acute MR is all about the diuretics and nitroprusside to get that afterload down.
  5. For MS with an area <1.5, it’s all about percutaneous mitral commissurotomy if there are symptoms or a high risk of thromboembolism.
  6. Pregnant lady needs a valve replaced? “In women who wish to become pregnant, the high risk of thromboembolic complications with a mechanical prosthesis during pregnancy—whatever the anticoagulant regimen used—and the low risk of elective reoperation are incentives to consider a bioprosthesis, despite the rapid occurrence of SVD in this age group.”
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