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Sim Lab 2 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Valvular Symptoms?

NAPPED-OF

A
  • Neurologocal Symptoms
  • Angina
  • Pedal Edema
  • Paroxysmal Nocturnal Dyspnea
  • Exercise Tolerance (MET’s)
  • Dyspnea
  • Orthopnea
  • Fatigability
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2
Q

Left sided valve disorders idenfified by what sounds?

A
  1. Pulmonary Rales (fine crackles)
  2. S3 Gallop
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3
Q

Right sided valve disorders idenfified by what?

A
  1. Jugular Vein distension
  2. Pedal Edema
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4
Q

Advanced methods to diagnose valvular disease?

A
  • TEE
  • TTE
  • Right heart cath
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5
Q

Blood Flow Path in Heart

A
  • IVC/SVC
  • RA
  • Tricuspid valve
  • RV
  • Pulmoary valve
  • Pulmonary Artery
  • LA
  • Mitrial Valve
  • LV Aorta
  • Aortic Valve
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6
Q

What is vena contracta?

A

The point in a fluid stream where the diameter of the stream is the least, and the fluid velocity is at its max

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7
Q

What is EROA?

A

Effective Regurgitant Orifice Area

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8
Q

What is PISA?

A

Proximal Isovelocity Surface Area

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9
Q

What is the basic summation of EROA?

A

The overall area of regurg

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10
Q

Annulus

A

Fibrous ring of tissue that can accommodate to the dynamic aspects of the myocardium and the valve leaflets

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11
Q

Tricuspid Valve Values

Normal

A
  • Valve Area: 4-6 cm^2
  • Annular Diameter: 23-33 mm
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12
Q

Tricuspid Valve Values

Regurg

A

Annular Diameter: >40 mm
Regurg Flow: >30%
Vena Contracta: ≥ 7 mm
EROA: ≥40 mm^2

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13
Q

Tricuspid Valve Values

Stenosis

A
  • Valve Area: < 1cm^2
  • Mean Gradient: 5-10 mmHg @ 70 bpm
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14
Q

Pulmary Valve Values

Normal

A

Valve Area: 2.5 - 4.0 cm^2

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15
Q

Pulmonary Valve Values

Regurg

A
  • Regurg volume: 30-59 mL
  • Regurg fraction: 30-49%

Moderate

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16
Q

Pulmonary Valve Values

Stenosis

A

Mean Gradient: 30-60 mmHg

Moderate

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17
Q

Mitral Valve Values

Normal

A

Valve Area: 4-6 cm^2

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18
Q

Mitral Valve Values

Regurg

A

Regurg volume: 30-59 mL
Regurg fraction: 30-49%
Vena Contracta: 0.3-0.69 cm
EROA: 0.2-0.39 cm^2

Moderate

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19
Q

Mitral Valve Values

Stenotic

A

Valve Area: 1.0-2.5 cm^2
Mean gradient: 6-10 mmHg

Moderate

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20
Q

Aortic Valve Values

Normal

A

Valve Area: >2.0 cm^2

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21
Q

Aortic Valve Values

Regurg

A

Regurg Volume: 30-49 mL
Regurg Fraction: 30-49%
Vena Contracta: 0.3-0.6 cm
EROA: 0.1-0.29 cm^2

Moderate

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22
Q

Aortic Valve Values

Stenotic

A

Valve Area: 1.0-1.5 cm^2
Mean gradient: 25-40 mmHg

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23
Q

Best heart rates for regurg?

A

Faster heart rates limit the time for backflow

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24
Q

Stenotic valves best heart rate?

A

Slower rates increase flow across the stenoic valve

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25
Q

Tricuspid Stenosis

A

Uncommon and associated with RHD

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26
Q

Tricuspid Stenosis managment

A

High Preload
Adequate contractablity

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27
Q

Right Atrial Dilation symptoms

J-PACHA

A
  • Jugular vein distension
  • Peripheral Edema
  • Ascities
  • Can induce arrythmias
  • Hepatomegaly
  • Anasarca

Anasarca is systemic edema

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28
Q

Tricuspid Regurg primary causes

A

Endocarditis
Carcinoid Syndrome
Ebstein Anomoly

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29
Q

Tricuspid regurg secondary causes

A

RV Dilation
Severe PHTN

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30
Q

Tricuspid Regurg Symptoms

A

Fatigue
Edema
Ascities

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31
Q

Tricuspid Regurg Treatments

A

Volume/Salt reduction
Diuretics
Reduce PHTN if present

Endothelin Receptor Antagonists: “sentan’s”
Phosphodiesterase Inhibitors: Viagra/Cialis “fil”

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32
Q

Manage PHTN

A

NO
sentan’s
fil’s

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33
Q

Manage RHF

A

Milrinone
Dobutamine

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34
Q

Managing Tricuspid Regurg

A

Maintain volume
Heart rate: normal to elevated

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35
Q

Tricuspid Regurg and neuraxial techniques

A

Controversial
* if RHF present then a decrease in coronary perfusion pressure could be bad

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36
Q

Pulmonic stenosis is most common in which demographic?

A

Pedi’s

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37
Q

Pulmonic stenosis does what?

2

A
  1. RV remodeling to compensate
  2. Usually asymptomatic until severe levels of stenosis present
38
Q

Pulmonic stenosis management

A
  • Preserve RV preload
  • Preserve RV contractability
  • Avoid increased PVR
39
Q

Pulmonic Regurg Primary Causes

A

Endocarditis
Carcinoid Syndrome
Iatrogenic

40
Q

Pulmonic Regurg Secondary Cause

A

Pulmonary Artery dilation

41
Q

Pulmonic Regurg Management

A

Reduce PHTN if present
Maintain RV function

42
Q

Mitral Stenosis mostly due to what?

A

Rheumatic fever

43
Q

Mitral Stenosis
* Mild to moderate

A

Minimally increased left atrial volume / pressure
Increase in HR can casue symptoms

44
Q

Mitral Stenosis
* Severe

A

Increased LA pressure / volume
Symptoms at rest

45
Q

Mitral Stenosis
* Symptoms by stressor

PEFS

A
  • Pregnancy
  • Emotional Stress
  • Fever
  • Sepsis
46
Q

Mitral Stenosis
* Main Symptoms

PROTEA

A
  • Pulmonary Hypertension
  • RHF
  • Ortner Syndrome
  • Thromboembolism risk
  • Exertional Dyspnea
  • Afib

Ortner: LA compression on Recurrent Laryngeal Nerve (RLN)

47
Q

Why is mitral stenosis a thrmboembolis risk?

A

LA appendage

48
Q

Mitral Stenosis Physical Exam

P-PICA

A
  • Pulmoary Rales
  • Peripheral Edema
  • Increased Jugular Venous Pressure
  • Cutaneous Vasodilation
  • Ascities
49
Q

What are Mitral Facies?

A type of cutaneous vasodilation

A

Pink-purple patches on cheeks
* Sign of Mitrial Stenosis

50
Q

What three types of remodeling does mitral stenosis cause?

A
  1. LA hypertrophy
  2. R Heart changes
  3. Intersitial Fibrosis
51
Q

HR for Mitral stenosis and which drug?

A

Slow it down for more filling time with BB

52
Q

Mitral Stensos and anticoag?

A

Yes is Afib present
Epidural > Spinal

53
Q

Mitral Stenosis and CO

A

prevent and treat any decrease in CO

54
Q

Avoid what in Mitral Stenosis?

KISS

A

Ketamine for induction
Increased PVR
Suddent drops in SVR
Signs of any new Afib or tachyarrhythmias

55
Q

Mitral Regurg
* Acute

2 things

A

Papillary muscle ischemia or infarction
Papillary muscle rupture

56
Q

Mitral Regurg
* Chronic

ACME

A
  • Annular dilation
  • Chordae incompetance
  • Myxoma
  • Endocarditis

Myoxma: Begnin growth in atria on a stalk that sways in the blood flow getting trapped in the valve not letting it close properly

57
Q

Why does Mitral regurg cause dereased CO?

A

Part of LV contraction is squeezed back in the LA

58
Q

Mitral Regurg: As the blood backs up, what happend?

A

LV Hypertrophy
LHF
Pulmoary edema
RHF

If RHF occurs then we have bi-ventricular failure = death

59
Q

Mitral regurg is asymptomatic until when?

A

LV enlargement
New onset pulmonary HTN
New onset Afib

60
Q

Mitral regug symptoms

A

DOE
Fatigue

61
Q

What two things can cause a mitral valve prolapse

A
  1. leaflet tenting into LA
  2. connective tissue disorder
62
Q

What is the most common precursor to Mitral valve regurg?

A

Mitral Valve prolapse

63
Q

Mitral Regurg Anesthestic goals

FULL-FAST-FORWARD

A

Keep Euvolemic (Full)
Normal to elevated HR (Fast)
Maintain contractability (Forward)

Also: Reduce afterload (Forward) with neuraxial techniques

64
Q

What drugs are given to help with LV dysfuntion and Mitral regurg?

2

A

Vasodilators
Inotropes

65
Q

What do we avoid in Mitral Regurg?

A
  • Sympathetic responses (acute rises in SVR)
  • Increases in PVR
    1. Hypercarbia
    2. Hypoxia
66
Q

Aortic Stenosis
* High Association with?

HARSH-DM

A
  • HTN
  • Atherosclerosis
  • Rheumatic Fever
  • Smoking
  • Hypercholesterolemia
  • Diabetes
  • Males
67
Q

Who will eventually get aortic stenosis?

A

Everyone who live long enough

68
Q

Bicuspid Aortic Valve

A

common cause of aortic stenosis

69
Q

Aortic Stenosis: What does limiting flow cause in the heart?

HAIL-LVH

A
  • Higher LV pressures to maintaine SV
  • Angina without CAD
  • Increased O2 demand with decreased O2 supply
  • Limited cardiac reserve

LVH: Left ventricualr hypertrophy caused by increased pressures will eventually fail to compensate for the the reduction in CO = heart failure

70
Q

Aortic Stenosis Symptoms

A

AS Triad
Once symptoms arise survival decline

These symptoms occure later in the disease progresson state

71
Q

Aortic Stenois triad

SAD

A
  1. Syncope
  2. Angina
  3. DOE
72
Q

Aortic Stenosis Anesthesia Goals

A

Maintain preload
Normal HR
No excess chronotropics

73
Q

Aortic Stenosis: Avoid what in mangement

A

Hypotension
Abrupt reduciton in SVR

Regional not advised

74
Q

Aortic Regurg caused by what three things

BOA

A

Bicuspid abnormality
Obstruction
Annular Dilation

75
Q

What types of obstruction can cause Aoritc regurg

3

A
  1. Calcification
  2. Myxoma
  3. Endocarditis
76
Q

What three things can cause annular dilation in aortic regurg?

A
  1. Aortic root
  2. LVOT
  3. Connective tissue disorder
77
Q

What does aortic regurg do to the heart?

3

A

Increased LV end-diastolic volume / pressure
Acute: Ischemia
Chronoic: LV Hypertrophy to compensate

78
Q

Aortic regurg symptoms

RABID-HD

A
  • Reduction in diastolic pressure
  • Angina
  • Bradycardia
  • Increased regurg volume
  • DOE
  • Heart Failure
  • Decreaed CPP
79
Q

Aortic regurg treatment

A

Decrease SVR
Diuretics
Surgical intervention

80
Q

Aortic regurg anestetic goals

FULL-FAST-FORWARD

A

Forward LV SV
Reduce SVR with vasodilators
Inotropes

Blunt symptheitc responses with narcs (but avoid bradycardia)

81
Q

Avoid what in aortic regurg

A

High dose volatile agent
Fast wake up (abrupt causes increase in SVR)

82
Q

Infective Endocarditis

A

Bacterial infection usually on heart valves

Dental procedures, Respiratory infections, skin infections, and toal joint infections

83
Q

Infective Endocardidtis usually presents as?

A

Regurg valve

84
Q

HOCM

A

Hypertrophic Obstructive Cardiomyopathy

85
Q

HOCM signs and symptoms

P-DITCH

A

Palpitaions
DOE
Initial signs can be DEATH
Tachydysrythmias
Chest Pain
Heart Failure

86
Q

HOCM mimics what?

A

Mitral regurg and Aortic stenosis

87
Q

HOCM PeriOp Management Drugs

A
  • BB
  • CCB
  • Volatile Agents
88
Q

HOCM PeriOp Management

A

Regional can be used
Prompt fluid replacement

89
Q

HOCM Contraindicated Meds

A

Ephedrine
Dopamine
Dobutamine

90
Q

Heart Transplant concerns

A

Immunosupressed
De-innervated Heart
2 P waves
No vagal tone
Delayed response to Hypotension/Hypovelimia

91
Q

Heart Transplant Abx

A

Cyclosporine: causes hyptertension and nephrotoxic
Tacrolimus: nephrotoxic

Sim Lab 2 (6 decks)

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