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Clinical Methods 2 > Cardiac Disorders and 12 Lead EKG Part 2 > Flashcards

Cardiac Disorders and 12 Lead EKG Part 2 Flashcards

1
Q

Nearly all MIs are coused by thrombotic occlusion of a coronary artery. True or false?

A

True

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2
Q

What are anesthetic considerations for mitral stenosis to AVOID? (4)

A
  • tachycardia
  • increases in blood volume (overtransfusion/head down position)
  • decreases in systemic vascular resistance
  • arterial hypoxemia/hypoventilation–this will exacerbate pulmonary HTN
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3
Q

What condition is usually due to rheumatic fever and is almost always associated with mitral stenosis?

A

Mitral regurgitation

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4
Q

Mitral Regurgitation

Left atrium volume overload is the principal change caused by a (increase/decrease) in forward left ventricle stroke volume.

A

decrease

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5
Q

Severe mitral regurgitation occurs when regurgitant fraction > ____%.

A

60

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6
Q

The fraction of the stroke volume that enters the left atrium depends on: (3)

A
  • size of mitral valve orifice
  • HR
  • pressure gradient across MV
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7
Q

The following are diagnoses of what following condition?

  • Holosystolic apical murmur
  • Eccentric cardiac hypertrophy/enlargement on PE
  • Echo confirms enlargement of LV chamber
  • color flow doppler revelations
A

Mitral regurgitation

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8
Q

What are treatments for mitral regurgitation? (2)

A
  • early surgical treatment by MV repair
  • MV replacements: attempts made to conserve MV apparatus/LV function to preserve LV contraction
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9
Q

Mitral regurgitation anesthetic management: (4)

A
  • avoid sudden decreases in HR
  • avoid sudden increases in SVR (systemic venous return)
  • minimize drug-induced myocardial depression
  • monitor magnitude of regurgitant flow with echo/pulmonary catheter
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10
Q

What condition describes the “billowing of the posterior mitral leaflet into the LA during systole”?

A

Mitral valve prolapse

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11
Q

Mitral valve prolapse is associated with: (2)

A
  • mid-systolic click
  • late systolic murmur

Aka click-murmur syndrome

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12
Q

What is the most common form of valvular heart disease in 2.4% of the US population?

A

Mitral valve prolapse

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13
Q

Mitral valve prolapse is not benign and has been associated with cerebral embolic events, infective endocarditis, severe MR, and sudden death. True or false?

A

False

It is relatively benign, but the conditions mentioned are true in serious cases.

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14
Q

If diagnosis is:

  • redundant and thickened leaflets (anatomic form)
  • mild bowing and normal appearing leaflets (functional form)

What heart disease does this describe?

A

Mitral valve prolapse

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15
Q

In mitral valve prolapse, redundant and thickened leaflets (anatomic form) will not need endocarditis prophylaxis. True or false?

A

False, does need prophylaxis

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16
Q

In mitral valve prolapse, mild bowing and normal-appearing leaflets (functional form) does not need endocarditis prophylaxis. True or false?

A

True

17
Q

Anesthetic management for mitral valve prolapse is the same for mitral regurgitation. True or false?

A

True

  • Avoid sudden decreases in HR
  • Avoid sudden increases in SVR
  • Minimize drug-induced myocardial depression
  • Monitor magnitude of regurgitant flow
18
Q

Increase LV emptying can accentuate MVP leading to _____ _____ .

A

mitral regurgitation

19
Q

What can increase LV emptying? (3)

A
  • increased sympathetic NS activity
  • decreased SVR
  • sitting position
20
Q

An idiopathic disease resulting from degeneration and calcification of aortic leaflets describes what disease?

A

Aortic stenosis

21
Q

What disease is more likely to occur in persons born with bicuspid aortic valves than with normal tricuspid valves?

A

aortic stenosis

Note: AS develops earlier (age 30-40) in bicuspid valves than with tricuspid valves (age 60-80)

22
Q

What disease has increased incidence of sudden death?

A

Aortic stenosis

23
Q

Risk factors for aortic stenosis: (2)

A

same as ischemic heart disease

  • HTN
  • hypercholesterolemia
24
Q

Aortic stenosis is characterized by obstruction to ejection of blood into the aorta due to decreases in the area of the AV orifice which (decrease/increase) LV pressures to maintain forward SV.

A

increase

25
Q

Critical AS when:

  • transvalvular pressure = ____ mmHg
  • orific area < ___cm2
A

50

0.8

26
Q

These symptoms commonly describe what heart disease?

  • angina pectoris
  • dyspnea on exertion
  • syncope (associated with exertion)
A

aortic stenosis

27
Q

Aortic stenosis physical exam diagnosis: detection of a _______.

A

murmur

More specifically, a systolic ejection murmur that radiates to the neck best heard in the aortic area( 2nd right ICS)

28
Q

Tests to confirm aortic stenosis: (3)

A
  • CXR: prominent acending aorta is indicated
  • ECG: evidence of left ventricular hypertrophy
  • ECHO: shows thickening and calcification of AV and decreased mobility of valve leaflets
29
Q

Treatment for aortic stenosis: (2)

A
  • No medical management except for endocarditis, then antibiotic prophylaxis
  • Aortic valve replacement
30
Q

Anesthetic considerations for aortic stenosis: (4)

A
  • maintain NSR (normal sinus rhythm)
  • avoid bradycardia
  • avoid sudden increases or decreases in SVR
  • optimize intravascular fluid volume to maintain venous return and LV filling
31
Q

What results from disease of the aortic leaflets or the aortic root that distorts the leaflets, preventing their coaptation?

A

aortic regurgitation

32
Q

The following causes describe what heart disease?

  • Leaflet abnormalities: infective endocarditis & rheumatic fever
  • Aortic root causes: idiopathic root dilation associated with HTN and aging, thoracic aortic dissection, collagen vascular diseases, and Marfan syndrome
A

Aortic regurgitation

33
Q

The magnitude of aortic regurgitant flow depends on: (2)

A
  • time available for regurgitation–HR
  • pressure gradient across the AV-SVR

Clinical Methods 2 (11 decks)

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