Thread by @GUH_ICU_Anaesth

1/8
You are asked to preoperatively assess a patient with known primary severe mitral regurgitation for an hip replacement

Which of the following new findings might result in you postponing surgery:

Dilated LV
Impaired LV sys fxn
Pulmonary HTN
New Afib

2/8

Answer:

Any/all of the above

If known severe MR – these are the NEW findings that should prompt you to speak to you friendly cardiologist colleagues

3/8

Valvular Heart Dx (VHD) AHA guidelines :

4/8

So what are the standard criteria?

5/8

Here is an easier algorithm from ESC 2017

6/8

So in PAC when should I order and echo on an Asymptomatic patient with known severe primary MR?

7/8

What about asymptomatic Moderate MR?

If preserved LV function – echo performed every 1-2yrs a per ESC and AHA

8/8

To recap -
Red flags for pre op assessment of patients with known severe primary MR:
1. Symptoms
2. Impaired LV systolic function
3. Dilated LV
4. Pulmonary hypertension
5. Atrial fibrillation

@COAIrl @IPOMS4 @AnaesTrainees
#MedTwitter #echofirst