Sandbox Rim: Difference between revisions

Revision as of 13:01, 22 July 2014

Mitral Stenosis

Abbreviations: AF: atrial fibrillation; MR: mitral regurgitation; MS: mitral stenosis; MVA: mitral valve area ; MVR: mitral valve replacement/repair ; PCWP: pulmonary capillary wedge pressure; PMBC: percutaneous mitral balloon commissurotomy; T_1/2: pressure half-time

Determine the severity of mitral stenosis (MS)

Very severe MS
❑ MVA ≤1 cm2
❑ T1/2 ≥220 ms

Severe MS
❑ MVA ≤1.5 cm2
❑ T_1/2 ≥150 ms

Progressive MS
MVA >1.5 cm2
T_1/2 <150 ms

Is the patient symptomatic?

No
( Stage C)

Yes
(Stage D)

No
(Stage C)

Yes
With no other cause for the symptoms

Does the patient have:
❑ Favorable valve morphology
AND
❑ No left appendage clot
AND
❑ No or mild MR

Does the patient have:
❑ Favorable valve morphology
AND
❑ No left appendage clot

AND
❑ No or mild MR

Is there a new onset of AF?

Order an exercise stress test

No

Yes

No

Yes

No

Is PCWP> 25 mm Hg?

Does the patient have:
❑ NYHA class III-IV symptoms
AND
❑ High surgical risk

Does the patient have:
❑ Favorable valve morphology
AND
❑ No left appendage clot
AND
❑ No or mild MR

No

Yes

No

Yes

No

Periodic monitoring

PMBC (Class IIa)

PMBC (Class I)

MVR (Class I)

PMBC (Class IIb)

Periodic monitoring

PMBC (Class IIb)

Periodic monitoring

@@ Line 1: / Line 1: @@
 ==Mitral Stenosis==
-<span style="font-size:85%">'''Abbreviations:''' '''AF''': [[atrial fibrillation]]; '''MS:''' [[mitral stenosis]]; '''MR:''' [[mitral regurgitation]]; '''MVA:''' mitral valve area ; '''MVR:''' mitral valve replacement/repair ; '''PCWP:''' pulmonary capillary wedge pressure; '''PMBC:''' percutaneous mitral balloon commissurotomy; '''T<sub>1/2</sub>:''' pressure half-time</span>
+<span style="font-size:85%">'''Abbreviations:''' '''AF''': [[atrial fibrillation]]; '''MR:''' [[mitral regurgitation]]; '''MS:''' [[mitral stenosis]]; '''MVA:''' mitral valve area ; '''MVR:''' mitral valve replacement/repair ; '''PCWP:''' [[pulmonary capillary wedge pressure]]; '''PMBC:''' percutaneous mitral balloon commissurotomy; '''T<sub>1/2</sub>:''' pressure half-time</span>
 {{Familytree/start}}
 {{Family tree | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | A01= <div style="float: left; text-align: left; width: 8em; padding:1em;">'''Determine the severity of [[mitral stenosis]] (MS)'''</div>}}
@@ Line 10: / Line 10: @@
 {{Family tree | | | C01 | | | | | | | C02 | | | | | | | | | | | C03 | | | | C04 | | | C01= No <br> ([[Mitral stenosis resident survival guide#Classification| Stage C]])| C02= Yes <br> ([[Mitral stenosis resident survival guide#Classification|Stage D]])| C03= No <br> ([[Mitral stenosis resident survival guide#Classification|Stage C]])| C04= <div style="float: left; text-align: left; width: 8em; padding:1em;">Yes <br> With no other cause for the symptoms </div>}}
 {{Family tree | | | |!| | | | | | | | |!| | | | | | | | | | | | |!| | | | | |!| | | | }}
-{{Family tree | | | D01 | | | | | | | D02 | | | | | | | | | | | |!| | | | | |!| | | | D01= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ Favorable valve morphology <br> AND <br>❑ No [[left appendage]] clot <br> <br> AND <br>❑ No or mild [[MR]] </div>| D02= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ Favorable valve morphology <br> <br> AND <br>❑ No [[left appendage]] clot <br><br> AND <br> ❑ No or mild [[MR]] </div>}}
+{{Family tree | | | D01 | | | | | | | D02 | | | | | | | | | | | |!| | | | | |!| | | | D01= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ Favorable valve morphology <br> ''AND'' <br>❑ No [[left appendage]] clot <br> ''AND'' <br>❑ No or mild [[MR]] </div>| D02= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ Favorable valve morphology <br> ''AND'' <br>❑ No [[left appendage]] clot <br><br> ''AND'' <br> ❑ No or mild [[MR]] </div>}}
 {{Family tree | | | |!| | | | | | | | |!| | | | | | | | | | | | |!| | | | | |!| | | | }}
 {{Family tree | | | |!| | | | | | | | |!| | | | | | | | | | | | D03 | | | | D04 | | | | D03= <div style="float: left; text-align: left; width: 8em; padding:1em;">Is there a new onset of [[AF]]? </div>| D04= <div style="float: left; text-align: left; width: 8em; padding:1em;">Order an exercise stress test </div>}}
@@ Line 16: / Line 16: @@
 {{Family tree | E01 | | E02 | | E03 | | | | E04 | | | | | | E05 | | E06 | | E07 | | | E01= No| E02= Yes| E03= Yes| E04= No| E05= Yes| E06= No| E07= Is [[PCWP]]> 25 mm Hg?}}
 {{Family tree | |!| | | |!| | | |!| | | | | |!| | | | | | | |!| | | |!| |,|-|^|-|.| | }}
-{{Family tree | |!| | | |!| | | |!| | | | | F01 | | | | | | F02 | | |!| |!| | | |!| F01= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ [[NYHA class]] III-IV symptoms <br> AND <br> ❑ High surgical risk </div>| F02= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ Favorable valve morphology <br> <br> AND <br>❑ No [[left appendage]] clot <br> <br> AND <br>❑ No or mild [[MR]] </div>}}
+{{Family tree | |!| | | |!| | | |!| | | | | F01 | | | | | | F02 | | |!| |!| | | |!| F01= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ [[NYHA class]] III-IV symptoms <br> ''AND'' <br> ❑ High surgical risk </div>| F02= <div style="float: left; text-align: left; width: 8em; padding:1em;">Does the patient have: <br> ❑ Favorable valve morphology <br> ''AND'' <br>❑ No [[left appendage]] clot <br> ''AND'' <br>❑ No or mild [[MR]] </div>}}
 {{Family tree | |!| | | |!| | | |!| | | |,|-|^|-|.| | | |,|-|^|-|.| |!| |!| | | |!| | }}
 {{Family tree | |!| | | |!| | | |!| | | G01 | | G02 | | G03 | | G04 |!| G05 | | G06 | | G01= No| G02= Yes| G03= Yes| G04= No| G05= Yes| G06= No}}

Sandbox Rim: Difference between revisions

Revision as of 13:01, 22 July 2014

Mitral Stenosis

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