Eisenmenger's Syndrome

Question 1

How is Eisenmenger’s syndrome defined?

Answer 1

pulmonary HTN with reversed or bi-directional shunt. (end pathology for uncorrected congenital heart defects)

Question 2

what are some signs and symptoms of Eisenmenger’s?

Answer 2

DOE
Palpitations
Syncope
Cyanosis
Angina
Hemoptysis
Systolic murmur

Question 3

what are the 3 main shunt locations for patients with Eisenmenger’s?

Answer 3

Aorta (aortico-pulmonary septal defect)
Atrial (total anomalous pulmonary return)
Ventricular (VSD, Tricupid atresia, PS)

Question 4

describe the course of development in terms of pathophysiology?

Answer 4

L -> R shunt
Increased PVR and Pulmonary HTN
R -> L shunt
R sided cardiomegaly and heart failure

Question 5

congenital defects occur in ___% of live births

Answer 5

1%

Question 6

90% of patient’s that develop Eisenmenger’s from an ASD develop it when?

Answer 6

adulthood

Question 7

80% of patient’s that develop Eisenmenger’s from an ____ or ___ develop it during infancy

Answer 7

VSD PDA

Question 8

What is the predicted outcome for pregnancy with Eisenmenger’s?

Answer 8

45% maternal mortality

Question 9

what are some treatment therapies for Eisenmenger’s?

Answer 9

Surgery
Phlebotomy
O2 Therapy

Question 10

what are some complications from ES?

Answer 10

bleeding disorders
renal dysfunction
hemoptysis
cholelithiasis
gout
CVA
hypertrophic osteoarthropathy

Question 11

Patient’s with ES are not candidates for what type of device?

Answer 11

pacemaker

Question 12

what pulmonary changes occur with ES?

Answer 12

Decreased: Lung Capacity, Vital Capacity, FEV, Peak exp. flow rate, Compliance

Increased: residual volume, closing lung volume

Question 13

what should you avoid with ES patients?

Answer 13

hypercarbia
acidosis
hypoxia
increased LAP
increased pulmonary blood flow
Myocardial depression
extreme HR changes
decreased Venous return
Volume overload
vasodilation

Question 14

what does a R -> L shunt need to stay balanced?

Answer 14

decreased SVR

increased PVR

Question 15

what does a L -> R shunt need to stay balanced?

Answer 15

increased SVR

Question 16

What are some important anesthetic considerations for ES patients?

Answer 16

maintain CO and SVR
NO BUBBLES
IV drugs = fast
Inhaled agents = slow
careful fluid titration
Pain control (sympathetic discharge bad)
prolonged NDMR
low CO2

Question 17

Why would the SpO2 be monitored in both the R hand and L foot of an ES pt due to PDA?

Answer 17

changes in SpO2 can indicate changes in shunt flow