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Su: Sim Lab 2 > 34. Structural Cardiac > Flashcards

34. Structural Cardiac Flashcards

1
Q

preop testing for valvular anomalies

A

TEE
TTE
heart Cath
Echo

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2
Q

regurgitant valve

A

backflow

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3
Q

stenotic valve

A

restricting blood flow

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4
Q

valvular symptoms

A

low MET level
fatigability
pedal edema
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
angina
TIA/CVA

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5
Q

Left sided valvular anomaly

A

pulmonary rales
S3 gallop

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6
Q

right sided valvular anomally

A

jugular vein distension
pedal edema

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7
Q

best physical exam indication for valvular anomaly

A

auscultation

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8
Q

advanced exams for valvular anomalies

A

TEE
TTE
Right heart cath

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9
Q

heart valve order

A

toilet paper my ass

Tricuspid
Pulmonic
Mitral
Aortic

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10
Q

vena contracta

A

diameter of stream is least
fluid velocity is max

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11
Q

when is vena contracta measured

A

regurgitant valves

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12
Q

EROA

A

effective regurgitatnt orifice area

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13
Q

EROA is measured by

A

TEE doppler
PISA method

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14
Q

Annulus

A

fibrous ring of tissue that accommodates the dynamic myocardium and valve leaflets

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15
Q

how is annular diameter measured

A

TEE

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16
Q

what HR is ideal for regurgitation?

A

Faster HR
– allows for more forward flow
– limits backflow

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17
Q

what HR is ideal for stenosis

A

Slower HR
– increases flow across small valve

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18
Q

RH valves

A

Tricuspid
pulmonic

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19
Q

tricuspid stenosis SE

A

Right atrial dilation
- arrythmias
- jugular venous distension
- ascites
- peripheral edema
- hepatomegaly
- anasarca (general swelling)

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20
Q

what is tricuspid stenosis associated with

A

RHD
valvular disorders

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21
Q

tricuspid stenosis anesthetic managment

A

high preload
adequate contractility

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22
Q

causes of tricuspid regurge

A

endocarditis
carcinoid syndrome
ebstein anomaly

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23
Q

secondary causes of tricuspid regurge

A

RV dilation
severe PHTN

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24
Q

tricuspid regurge symptoms

A

RHF
fatigue
edema
ascites

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25
Q

tricuspid regurge treatment

A

decr fluids
decr salt
diuretics
decr PHTN

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26
Q

what drugs decr PHTN

A

endothelin receptor antag
PDE inhibitors

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27
Q

tricuspid regurge anesthetic

A

manage PHTN
manage RHF
mx volume status
normal HR

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28
Q

how do you manage PHTN

A

avoid hypoxia
avoid fluid overload
avoid hypercarbia

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29
Q

how do you manage RHF

A

milrinone
dobutamine

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30
Q

when are neuraxial techniques CI for tricuspid regurge

A

with tricuspid regurge and RHF

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31
Q

pulmonic stenosis is most common in what pt population

A

peds

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32
Q

pulmonic stenosis symtoms

A

asymptomatic until severe

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33
Q

pulmonic stenosis managment

A

preserve RV preload
preserve contractility
avoid PVR increases

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34
Q

pulmonic regurg primary causes

A

endocarditis
carcinoid syndrom
iatrogenic

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35
Q

iatrogenic causes of pulmonic regurge

A

catheter
surgery issues

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36
Q

seconday cause of pulm regurge

A

pulmonary artery dilation

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37
Q

pulmonic regurge management

A

decr PHTN
mx RV function

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38
Q

LH valves

A

mitral
aortic

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39
Q

cause of mitral stenosis

A

rheumatic fever

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40
Q

mild-mod mitral stenosis

A

slight incr LA P/V

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41
Q

what makes symptoms worse in mild-mod mitral stenosis

A

incr in HR

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42
Q

severe mitral stenosis

A

incr LA P/V at rest

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43
Q

what increases mitral stenosis symptoms

A

sepsis
fever
emotional stress
pregnancy

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44
Q

mitral stenosis symptoms

A

PHTN
PHF
exertional dyspnea
Afib
Ortner syndrome
thromboemolism risk

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45
Q

ortner syndorm

A

LA compression on RLN

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46
Q

ortner syndrome SE

A

chest/back/epigastric pain
cough
wheeze
stridor

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47
Q

mitral stenosis physical exam

A

rales
peripheral edema
ascites
incr jugular venous pressure
mitral facies (patches on cheeks)

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48
Q

mitral stenosis heart impacts

A

LA hypertrophy
R heart changes
interstitial fibrosis

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49
Q

mitral stenosis management

A

optimize HR
prevent decr CO
prevent pulm edema
treat Afib or arrythmias

50
Q

is epidural or spinal better for mitral stenosis

A

epidural

51
Q

how do you prevent pulmonary edema

A

decr preload
== avoid fluid overload

52
Q

what drug should you avoid in mitral stenosis

A

ketamine
– incr PVR
– decr SVR
–hypoxia
– hypercarbia

53
Q

causes of acute mitral regurge

A

ischemia of papillary muscle
papillary muscle rupture

54
Q

causes of chronic mitral regurge

A

annular dilation
endocardidits
chordae incopetence
myxoma

55
Q

myxoma

A

pedunculated benign heart growth

most common in atria

56
Q

mitral regurge CO

A

decreased

57
Q

mitral regurge

A

LV hypertrophy
LHF
Pulmonary edema
RHF

58
Q

mitral regurge symptoms

A

DOE
fatigue

59
Q

mitral valve prolapse

A

valve leaflet tents up into left atrial cavity

60
Q

cause of mitral valve prolapse

A

connective tissue disorder
- ehler danos
- marfans

61
Q

most common precursor to mitral regurge

A

mitral valve prolapse

62
Q

treatment for mitral valve prolapse

A

valve repaire
valve replacement
mitraclip

63
Q

mitral regurge management

A

fast HR
full CO
forward stroke volume

decr afterload

64
Q

how can you reduce afterload

A

neuraxial technique (epidural)

65
Q

how do you correct LV dysfunction

A

vasodilator
inotropic agent

66
Q

what should you avoid in mitral regurge

A

sympathetics (incr SVR)
hypoxia
hypercarbia
(incr PVR)

67
Q

what decr sympathetics

A

opioids

68
Q

most problematic valve dysfunction

A

aortic stenosis

69
Q

causes of aortic stenosis

A

rheumatic fever
atherosclerosis
HTN
hypercholesterol
diabetes
smoking
male
age

70
Q

aortic stenosis symptoms

A

syncope
DOE
angina

71
Q

when does survival start to be threatened with aortic stenosis

A

once symptoms onset

72
Q

TAVR

A

transfemoral aortic valve replacement

73
Q

what age is TAVR better for

A

> 65

74
Q

when is TAVR more risky

A

aortic root complication
low coronoary ostia height
LVOT calcification

75
Q

aortic stenosis managment

A

mx preload (normovolemia)
normal HR
maximize LV
avoid hypotension
avoid SVR decr

76
Q

is regional good for aortic stenosis

A

no

77
Q

causes of aortic regurge

A

leflet development anomaly
obstruction
annular dilation

78
Q

types of obstructions

A

calcification
myoxma
endocarditis

79
Q

type of annular dilation

A

aortic root
LVOT
connective tissue disorder

80
Q

aortic regurge

A

incr LV EDV/EDP

81
Q

chronic aortic regurge

A

LV hypertrophy

82
Q

acute aortic regurge

A

ischemia

83
Q

what should you mx in aortic regurge

A

forward LV stroke volume

84
Q

what should you avoid in aortic regurge

A

bradycardia
abrupt SVR incr
volume overload

85
Q

should you wakeup be fast or slow with aortic regurge

A

slow
- aovid SVR incr

86
Q

should you use high or low VA with aortic regurge

A

low VA
- high induces myocardial contractility depression

87
Q

infective endocarditis

A

presents most like a regurgitant valve

– sometimes stenotic

88
Q

cause of IE

A

frequent exposure of bacteria daily

89
Q

IE high risk pts

A

prosthetic heart valves
annuloplasty
history of IE
cyanotic HD w/shunts
cardiac transplant

90
Q

IE high risk procedures

A

dental
respiratory tract
infected skin
musculoskeletal
total joints

91
Q

cause of HOCM

A

autosoma dominant

92
Q

HOCM symptoms

A

death
DOE
palpitations
chest pain
tachydysrhthmias
HF

93
Q

HOCM can be induced with

A

rest
valsalva
exercise

94
Q

HOCM mimics

A

mitral regurge
aortic stenosis

95
Q

HOCM

A

enlarge IVS
LVOT
myocardial hypertrophy
diastolic dysfunction
prolonged relaxation
ischemia
dysrhthmias

96
Q

diastolic function causes

A

decr CPP

97
Q

is deep or awake extubation better with HOCM

A

deep

98
Q

what should you avoid in HOCM

A

incread outflow obstruction:
- incr myocardial contractility
- decr preload
- decr afterload

99
Q

what should you favor in HOCM

A

decreaed outflow obstruction:
- decr myocardial contractility
- incr preload
- incr afterload

100
Q

what incr myocardial contractility

A

beta stimulation
digitalis (digoxin)

101
Q

what decreases preload

A

hypovolemia
vasodilators
tachycardia
PPV

102
Q

what decreases afterload

A

hypotension
vasodilators

103
Q

what decr myocardial contractility

A

beta blockade
VA
CCB

104
Q

what incr preload

A

hypervolemia
bradycardia

105
Q

what incr afterload

A

HTN
alpha stimulation

106
Q

what drugs are CI with HOCM

A

ephedrine
dopamine
dobutamine

107
Q

can you use regional with HOCM

A

yes - plan ahead for impactys

108
Q

what can induce LVOT post-op

A

pain
anxiety
shivering
hypoxia
hypercarbia

109
Q

broken heart disease

A

AKA takotsubo
stress cardiomyopathy

110
Q

how do you manage broken heart disease

A

like HOCM

111
Q

when do you use intraortic balloon pump

A

if stress cardiomyopath is prolonged w/negative effects

112
Q

what gas is used in IABP

A

He

113
Q

what EF triggers need for cardiac transplant

A

<20%

114
Q

p wave is transplanted heart

A

2
-1st is pt
- 2nd is new heart

115
Q

is elevated or slow HR normal after transplant

A

slightly elevated

116
Q

do transplanted hearts respond to alpha and beta stimulation

A

yes
- indirect mechanisms are delayed

117
Q

does glyco/atropine work on transplanted heart

A

no

118
Q

transplanted heart

A

no sympathetics
no parasympathetics
no sensory
silent MI

119
Q

cyclosporine

A

anti rejection meds
HTN
nephrotoxicity

120
Q

tacrolimus

A

nephrotoxic

121
Q

transplanted heart is dependent on

A

preload

Su: Sim Lab 2 (18 decks)

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