44.3 🩺 內科專科考前版

44.3.0.1 📌 䞀頁重點

  • 22ETAVR expansion, MitraClip for MR, mavacamten for HCM
  • AHA/ACC valve guideline 2020 + 2023 update
  • Taiwanrheumatic MS 仍芋、TAVR 健保條件

44.3.0.2 💊 進階治療

44.3.0.2.1 AS
  • TAVR 為 standard for high/intermediate/䜎 risk (PARTNER 3)
  • Severe + symptomatic → AVR ASAP
  • Asymptomatic severe + LV dysfunction or stress test + → also AVR
44.3.0.2.2 MR
  • Primary: surgical repair > replacement
  • Secondary (functional): GDMT first
  • MitraClip (TEER) for high-risk
44.3.0.2.3 HCM
  • BB / non-DHP CCB
  • Mavacamten (cardiac myosin inhibitor) — 22E new
  • Septal myectomy / alcohol septal ablation
  • ICD for high-risk SCD
44.3.0.2.4 AR
  • Severe + symptomatic → AVR
  • Asymptomatic + LV dilation > 50 mm or EF < 55 → AVR
44.3.0.2.5 MS
  • Rheumatic mainly
  • Percutaneous balloon mitral valvuloplasty (PBMV) for selected (Wilkins score)
  • Surgery if PBMV unsuitable

44.3.0.3 🌟 Pearls (8)

  1. TAVR < 65 yo OK now (long-term data emerging)
  2. MitraClip for high-surgical-risk MR
  3. Mavacamten changing HCM therapy
  4. Wilkins score for PBMV eligibility
  5. Endocarditis prophylaxis for high-risk valve only (per AHA 2007)
  6. Bioprosthetic vs mechanical: age + AC compliance + 期望壜
  7. AF in MS = anticoagulation必芁
  8. Pulmonary HTN in MS / MR severe

44.3.0.4 📍 台灣 Context

  • TAVR 健保條件
  • Rheumatic disease 仍 endemic
  • PBMV 普及

44.3.0.5 🎓 內專重點

  1. Murmur 鑑別 + maneuvers
  2. AS / AR / MS / MR severe criteria
  3. HCM / MVP
  4. TAVR / MitraClip / mavacamten
44.3.0.5.1 跚章節
  • Ch 280-281 Valvular HD
  • Ch 268 HCM
  • Ch 144 IE

⚠ AI 草皿。