APEX Valvular Disease Flashcards
Where to listen to heart valves
Aortic- R sternal border 2IC
pulmonic- L sternal border 2 IC
tricuspid- L sternal border 4IC
mitral- L Midclavicular line 5 IC
Top two- most important- next to eachother (aortic first/pulmonic next)
Bottom two- from R to L just like in real heart
Which valvular diseases are associated with eccentric hypertrophy?
Regurg of mitral and aortic
Eccentric vs concentric hypertrophy
E-Dilated chamber + thin wall, regurg makes it wider
C- Smaller chamber + thick wall, stenosis makes it grow stronger to push thru
Does stenosis or regurg cause concentric hypertophy?
Stenosis
What produce sarcomeres in a parallel? in a series? what is it normally?
Concentric hypertophy (think, its thick so sarcomeres are parallel on top of eachother)
Eccentric hypertophy (think, it gets wider so sarcomeres are next to eachother)
Normal- just two sarcomeres
Normal area of opening of aortic valve
Normal valve- 2-4cm^2
Stenotic valve- <1cm
Causes of aortic stenosis
Most common- calcification of valve leaflets
Rheumatic fever
Infective endocarditis
How will aortic stenosis effect PV loop
Increases afterload, makes graph skinny and tall
Anesthetic considerations of tachycardia in AS
Cardioversion, BB
Dont speed up heart over 70-80
Anesthetic considerations for bradycardia in AS
Atropine
Glycopyrrolate
Ephederine
Why is spinal anesthesia avoided in severe aortic stenosis?
Spinal = sympathectomy reduces SVR, causing hypotension, reducing CPP, and causing cardiovascular collapse
How does aortic stenosis effect a line tracing?
Pulsus parvus - slow upstroke
Pulses tradus - small pulse pressure, line doesnt go down as low
No dicrotic notch
How does chronic aortic regurg look like on LV pressure loop?
Ejection is long af, though SV isnt long bc diastole is super short
How does mitral stenosis look on PV loop?
Small square- shifted down and left
Conditions that increase aortic regurgitation
Bradycardia (long filling time)
Increased SVR
Large valve orifice
How to manage AR
Maintain preload,
Increase HR to decrease filling time
maintain good inotropy
Decrease SVR
Regional anesthesia! decreases afterload and thus regurg amount
Aortic regurg effect on a line
(Bisferiens pulse) Biphasic- think the blood is going back to the heart, but has to go back to periphery again
Regurg on PV loop vs stenosis on PV loop
r- wide af but not too tall
s- not wide, more skinny since the valves dont open
MV size
normal- 4-6cm
Severe stenosis- 1cm
Causes of aortic regurg
endocarditis
Aneurysm or trama- aortic root dissection
MV stenosis causes
Rheumatic fever
endocarditis
atherosclerosis- calficiation
MV stenosis anesthetic management
Slower side of HR
Maintain Preload, inotropy
Dont drop SVR, as it can cause reflec tachycardia
Tret hypotension with phenyl- wont cause increase in hr like ephederine
ASSS ARDS MSDA MRSA
aortic stenosis systole murmur- sternal border
aortic regurg diastolic murmur - sternal border
Mitral stenosis diastole- apex
Mitral regurg systole - apex
TAVR valve options
SAPIAN and medtronic
Sapian vs medtronic corevalve
S- requires cardiac standstill (via RVR pacing) to place valve, baloon valvuloplasty
MCV- vave is self expanding, no need for rapid ventricles/cardiac standstill
Critical acute complications of improperly placed valve during TAVR?
Wide open aortic regurg
How to access for TAVR
Transfemoral
Transaortic
Transapical
s1 murmur s2
systolic
s1 s2 murmur
diastolic
Aortic stenosis hemodynamics
Well tolerates increased SVR bc the valve is already hard to open,
Causes of mitral stenosis murmur
SLE ash
RA
Endocarditis
Aortic regurg conditions
Ankylosing spondylitis
Marfan syndrom
Ehler danlos
What should be heard with bell of stethoscope?
s3 s4 diastolic murmurs
lower pitch
