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Fall'20 Advanced Principles II > EXAM 2 - CHD > Flashcards

EXAM 2 - CHD Flashcards

1
Q

Indications for cardiac surgery in adults with CHD include:

A

Primary Repair
Total correction after palliation
Revision of total correction
Conversion of suboptimal operation into more modern repair

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2
Q

**Wolff-Parkinson-White syndrome is associated with what CHD/lesion?

A

Ebstein’s anomaly

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3
Q

**A.Fib is associated with what CHD/lesion(s)?

A

Mitral Valve disease
Aortic Stenosis
Tetralogy of Fallot
Palliated single ventricle

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4
Q

**Ventricular Tachycardia is associated with what CHD/lesion(s)?

A

Tetralogy of Fallot
Aortic Stenosis
(others)

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5
Q

Spontaneous AV Block is associated with what CHD/lesion(s)?

A

AV Septal defects

Congenitally corrected transposition

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6
Q

Surgically induced AV Block is associated with what CHD/lesion(s)?

A

VSD Closure
Subaortic Stenosis Relief
AV Valve Replacement

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7
Q

Minute ventilation =

A

RR x TV

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8
Q

Any lesion that results in either increased pulmonary blood flow or pulmonary venous obstruction can cause what three things?

A
  1. ) increased pulmonary interstitial fluid with
  2. ) decreased pulmonary compliance and
  3. ) increased work of breathing.
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9
Q

**pts with cyanotic heart disease will have an increased ___ and maintain ____.

A

increased minute ventilation

maintain normocarbia
(they have a normal ventilatory response to hypercapnia but a blunted response to hypoxemia.)
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10
Q

patients with cyanotic heart disease have a normal ventilatory response to hypercapnia but a blunted

A

response to hypoxemia.

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11
Q

**What non cardiac issue can occur in approx. 19% of pts with CHD (most commonly in cyanotic pts)?

A

scoliosis

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12
Q

Is Eisenmenger Syndrome acyanotic or cyanotic CHD?

A

cyanotic

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13
Q

Describe Eisenmenger Syndrome:

A

a large VSD with displacement of aorta to the RIGHT

  • Occurs when intracardiac shunt reverse and becomes right to LEFT shunt
  • frequent in children but can occur in late stage adults
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14
Q

Longstanding hypoxemia causes increased red blood cell mass. Some CHD patients develop:

A
  • excessive HCT (Polycythemia)
  • and are Iron deficient

*Increased viscosity

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15
Q

what direction does iron deficiency shift the oxy-hgb curve?

A

RIGHT

decreasing O2 affininty for lungs

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16
Q

Adults with persistent or potential intracardiac shunts remain at risk for…

why?

A

Parodoxic embolism

-venous embolism passes through a lateral opening in the heart into arterial circulation.

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17
Q

Brain abscesses are associated with what in CHD patients?

A
  • they result from right to left shunts

- old brain abscess ==> seizures

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18
Q

End Stage Eisenmenger Syndrome is associated with what respiratory symptom?

A

hemoptysis

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19
Q

RLN injury is a potential noncardiac involvement in pts with CHD. Why?

A

prior thoracic surgery

rarely from encroachment of cardiac structures

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20
Q

Common hematologic involvement in CHD patients includes:

A
  • *Abnormal Von Willebrand factor
  • bleeding diathesis
  • symptomatic hyperviscosity
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21
Q

Cardiac Complications/ Peripartum endocarditis presents when? up to?

A

presents usually in the last month of pregnancy and up to 5 mos postpartum

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22
Q

in pregnancy, Most major physiologic changes occur prior to

A

the 3rd trimester.

IF patient has maintained good FUNCTIONAL status to this point, risk is dramatically lowered

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23
Q

During pregnancy, with CHD, what requires close observation?

A

bearing down that is associated with stage 2

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24
Q

Oxytocin to SVR, HR, PVR

A

decreases SVR

Increases HR and PVR

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25
Q

Methylergonovine (Methergine) to SVR

A

increases SVR

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26
Q

are oxytocin and methergine tolerated well or poorly in parturients with CHD?

A

both can be poorly tolerated

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27
Q

Beta blockers impact on fetus:

A
  • can interfere with fetal growth &

- response of fetus stress during labor

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28
Q

This medication can affect fetal thyroid function

A

Amiodarone

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29
Q

Maternal cardioversion can be safe during pregnancy with …

A

close fetal monitoring

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30
Q

Surgeries/treatments and palliative therapy performed as a child of CHD must be considered in:

A

the anesthetic management of the adult

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31
Q

Patients with the following CHD’s typically survive to adulthood without …..

-Bicuspid aortic valve
-Coarctation of aorta
Pulmonic Valve stenosis
Ostium secundum atrial septal defect
Patent ductus arteriosus

A

Treatment

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32
Q

Survival with some congenital anomalies depends on the simultaneous presence of

A

another shunting lesion

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33
Q

for birthing mothers with CHD - what delivery method is preferable?

A

no favored method (c/s or vaginal)

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34
Q

Lesions causing OUTFLOW obstruction:

A

Left Ventricle:

  • Aortic Stenosis
  • Coarctation of the aorta

Right Ventricle:
-Pulmonic valve stenosis

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35
Q

Lesions causing LEFT to RIGHT shunting:

A 
ASD
PDA
VSD
Endocardial cushion defect
Partial anomalous pulmonary venous return
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36
Q

Lesions causing Right to LEFT shunting – with DECREASED pulmonary blood flow:

A

Tetralogy of Fallot (TOF)
Pulmonary Atresia
Tricuspid Atresia

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37
Q

Lesions causing Right to LEFT shunting – with INCREASED pulmonary blood flow:

A 
Transposition of great vessels
Truncus arteriosus
Single ventricle
Double outlet Right Ventricle
Total anomalous pulmonary venous return
Hypoplastic Left heart
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38
Q

What CHD are cyanotic?

A

Tetralogy of Fallot (TOF)
Pulmonary Atresia
Tricuspid Atresia

Right to LEFT shunting – with DECREASED pulmonary blood flow

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39
Q

dental prophylaxis is important for CHD survivors due to

A

bacterial endocarditis

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40
Q

Tell me the difference b/w concentric and eccentric hypertrophy

A

Concentric = pressure overload hypertrophy

Eccentric = Volume overload hypertrophy

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41
Q

aortic stenosis is what kind of hypertrophy?

A

concentric

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42
Q

Aortic stenosis is the MCC of

A

obstruction to LV outflow

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43
Q

in Aortic stenosis, obstruction to ejection of blood into aorta d/t decreases in aortic valve area results in:

A

an increase in LV pressure to maintain forward flow

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44
Q

size of normal aortic valve =

severe stenosis =

A

2.55-3.5 cm2

less than or equal to 1.0cm2

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45
Q

pts with aortic stenosis may experience angina w/o CAD due to

A

increased O2 supply to the sub-endocardium by the reduced ventricular compliance

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46
Q

a decrease in atrial kick in NSR will decrease ventricular filling and may lead to what % reduction in CO?

A

40% reduction of CO

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47
Q

s/s of aortic stenosis

A

“SAD”
Syncope
Angina
Dsypnea on exertion

LV pressure Overload

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48
Q

what type of murmur is heard (where?) with aortic stenosis?

A

systolic murmur at 2nd ICS to the Right

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49
Q

Contraindications in severe aortic stenosis

A

spinals and epidurals

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50
Q 
Aortic Stenosis Goals:
-HR:
Rhythm:
Preload:
Afterload:
Contractility:
A

-HR: maintain 60-90bpm avoid brady/tachy; SV fixed
Rhythm: NSR!!
Preload: maintain and optimize
Afterload: maintain to CPP; avoid sudden in/decreases
Contractility: maintain

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51
Q

In Aortic Stenosis, Avoid :

A
  • brady or tachy
  • hypotension - tx with small doses of neo
  • decreases in CO
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52
Q

how would you tx bradycardia in AS?

A

atropine! (faster)

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53
Q

how would you tx tachycardia in AS?

A

esmolol (cardiac specific; fast)

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54
Q

name the two types of aortic coarctation

A
  1. ) Preductal (infantile) - narrowing occurs proximal to the opening of the ductus
  2. ) postductal - s/s severity depends on severity of narrowing and extent of collateral circulation that develops to the lower body
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55
Q

coarctation of aorta the obstruction is usually located in the

A

descending aorta

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56
Q

in preductal coarctation, what part is cyanotic?

A

the lower half is cyanotic

-marked difference in perfusion b/w the upper and lower halves of the body - lower half is cyanotic - perfusion to the upper half is derived from aorta, while perfusion to lower half is derived primarily from pulmonary artery.

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57
Q

What % of patients with CHD do we see scoliosis in?

are these patients cyanotic or acyanotic?

A

approx. 19% of pts with CHD

most commonly in cyanotic pts

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58
Q

an attempt to increase pulmonary blood flow, large collateral vessels originating from the aorta may develop… this is the result of:

A

Eisenmenger Syndrome

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59
Q

3rd stage (delivery of the placenta) can be associated with 3 issues/complications:

A
  1. hypovolemia
  2. uterine atony
  3. hemorrhage
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60
Q

Tell me about atrial kick:

What is it normally (%)?
When do we most often lose it?

A

30%

lost in a.fib

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61
Q

ECG may show LV hypertrophy while an ECHO shows

A

severity

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62
Q

in AStenosis; how would you tx hypotension?

A

small doses of Neo

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63
Q

with COA, what happens with mortality risk if unrepaired in an adult?

A

Mortality increases with age:

25% by age 20 —90% by age 60

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64
Q

Common complications of COA in adults include persistent:

A
  • persistent HTN
  • aneurysm
  • premature coronary atherosclerosis
  • LVFailure
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65
Q

during pregnancy in COA, what is exacerbated?

A

HTN

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66
Q

Pulmonic stenosis is what type of hypertrophy?

A

concentric

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67
Q

This heart defect obstructs RV outflow and causes concentric RVH and post-stenotic dilation of pulmonary artery:

A

pulmonic stenosis

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68
Q

Symptoms of Pulmonary stenosis:

A

same as RVHF:

  • fatigue
  • SOB
  • -peripheral cyanosis w/exertion
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69
Q 
Pulmonic Stenosis Goals:
-HR:
Rhythm:
Preload:
Afterload:
Contractility:
A

-HR: maintain normal or slightly elevated HR
Rhythm: NSR!!
Preload: augment
Afterload: maintain to CPP; avoid sudden in/decreases
Contractility:

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70
Q

what do you want to avoid with pulmonic stenosis?

A

Increasing PVR

  • hypoxia
  • acidosis (pulm vasoconstriction)
  • PE
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71
Q

Atrial septal defects (ASD) results from incomplete septal formation.

  • What type of shunt is this b/w the atria?
  • Name the three types of ASDs
A
  • ASD is Left to right shunt
  1. Ostium Secundum
  2. Ostium Primum
  3. Sinus Venosus
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72
Q

the most common ASD is;

A

ostium secundum

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73
Q

this type of ASD is located high in the atrial septum

A

sinus venosus

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74
Q

this type of ASD is located low inthe atrial septum

A

ostium primum

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75
Q

this type of ASD is at the level of the foramen ovale

A

Ostium secundum

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76
Q

what type of murmur is associated with ASD?

A

Holosystolic murmur secondary to MR

- Ostium Primum type

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77
Q

in the absence of CHF, anesthetic responses to inhalation and IV agents with ASD are

A

generally not altered

** Volatiles decrease SVR and Increase PVR –> decreasing shunt

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78
Q

in ASD, what do we want to AVOID?

A
  • Air in IV tubing

- Increases in SVR (worsen L-to-R shunting)

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79
Q

What conduction defects are common in ASD pts early post op?

A

SVT and AV conduction defects

80
Q

This defect is most commonly in the inter-ventrcular septum and causes communication b/w R and LV’s:

A

VSD

L to R shunt

81
Q

Name the 4 types of VSDs. Which is most common?

A
  1. Membranous VSD (MOST COMMON)
  2. Muscular VSD
  3. Supra-cristal VSD
  4. AV canal type VSD
82
Q

VSD present with what s/s?

A
  • most asymptomatic

- loud pan systolic murmur along left sternal border

83
Q

what murmur is heard with VSD? location?

A

oud pan systolic murmur

along left sternal border

84
Q

in the absence of CHF, anesthetic responses to inhalation and IV agents with VSD are

A

generally not altered

85
Q

These complications are common in VSD pts

A

Recurrent Pulmonary Infections

CHF

86
Q

Increases in SVR worsen these types of shunts:

A

Left to Right

-Goal is to decrease SVR; Volatiles

87
Q

What post-op complication may present after VSD repair?

A

3rd HB TROUBLE!!

88
Q

Goal in VSD patients is to

A 
Increase PVR (induce PPV)
avoid a decrease in PVR

Decrease SVR

89
Q

Left to right shunt reversal syndrome is known as

A

Eisenmenger’s syndrome (right to left shunt)

90
Q

situation in which left to right intra-cardiac shunts are reversed d/t INCREASED PVR levels = to or > than SVR

A

Eisenmenger’s syndrome

91
Q

Eisenmenger’s syndrome occurs in approx what % of pt w/large VSDs?

A

50%

92
Q

Eisenmenger Syndrome the shunt becomes:

A

RIGHT to Left (cyanotic)

-decreased pulm BF resulting in arterial hypoxemia

93
Q

clubbing and cyanosis are associated s/s of

A

Eisenmenger’s syndrome

94
Q

Common lesion in pts with Down syndrome is:

A

Atrioventricular septal defects

95
Q

Atrioventricular septal defects result from inadequate fusion of the endocardial cushions during fetal life. This produces atrial and ventricular septal defects often w/very abnormal

A

AV Valves

-can produce large shunts in both atria and ventricles

96
Q

Atrioventricular septal defects often result in mitral and tricuspid regurgitation. this regurgitation leads to what?

A

volume overload of ventricles

97
Q

Atrioventricular septal defects shunt in which direction?

A

initially Left to Right

-with increasing PHTN, Eisenmenger syndrome develops with cyanosis (and RIGHT to left shunting)

98
Q

persistence of communication b/w the main pulmonary artery and aorta is what defect?

A

Patent ductus arteriosus (PDA)

99
Q

Anesthetic goals for PDA are:

A

like ASD and VSD

-generally unchanged

100
Q

Treatment of PDA

A

Indomethacin - result in PDA closure

surgical ligation via left thoracotomy incision after pt is 2 yrs

101
Q

PDA is associated with what post-op?

A

HTN

may require tx with vasodilator

102
Q

PDA is a shunt that goes which direction?

A

Left to right

103
Q

Partial anomalous venous return (PAVR) occurs when on or more pulmonary veins drain into the right side of the heart (veins are usually from the right lung).

Entry sites include:

A
  • RA
  • SVC
  • IVC
  • Coronary Sinus
104
Q

clinical course and prognosis for pts with PAVR is:

A

excellent

105
Q

PAVR shunts in what direction?

A

left to right

106
Q

“mixing lesions” are also called:

A

right to left complex shunts

107
Q

atresia of any one of the cardiac valves represents an extreme form of obstruction. Shunting occurs proximal to the atretic valve and is completely

A

fixed

108
Q

in Right to left shunts, survival depends on

A

another distal shunt; where BF is in opposite direction

  • PDA
  • PFO
  • ASD
  • VSD
109
Q

Tetralogy of Fallot (TOF) is the most common:

A

cyanotic defect

110
Q

Name the 4 characteristics of TOF:

A
  1. pulmonary stenosis (RV outflow obstruction)
  2. Overriding aorta
  3. VSD
  4. RV hypertrophy
111
Q

TOF shunts in what direction? a/cyanotic?

A

Right to left

cyanotic

112
Q

in TOF; the combination of RV obstruction and VSD results in…

A

Mixed blood:
-ejection of unoxygenated blood from RV
and
-oxygenated blood from LV into the Aorta

**arterial hypoxemia

113
Q

Right to left shunting has both FIXED and VARIABLE shunting.

What do each depend on?

A

Fixed shunt depends on obstruction

Variable shunt depends on SVR and PVR

114
Q

What is IV Prostaglandin E1 used for?

A

to keep PDA open in neonatees with severe RV obstruction

-When/if the PDA is allowed to close, these neonates decrease their pulmonary BF and deteriorate rapidly

115
Q

TET spells occur in what % of children with TOF?

A

35%

116
Q

What is the etiology of TET spell?

A

Hypoxemic cyanotic events exaggerated with changes in magnitude of Right to left shunt

117
Q

Causes of TET spell include:

A
  • Increased PVR (Crying , acidosis, airway obstruction)
  • Increased O2 requirement (infection)
  • Decreased Pulm BF d/t spasm (infundibular cardiac muscle)
  • Decreased SVR (vasodilation)
  • Decreased Blood Vol/ CO (dehydration)
118
Q

how do you treat a TET spell?

A
  • Hyperventilate - 100% FIO2
  • Fluids for volume (10-20ml/kg)
  • Neo (5-20mcg/kg)
  • Beta blockers (propranolol/ esmolol)
  • Morphine
119
Q

What complication is common in children with severe TOF?

A

CVA

120
Q

Anesthetic management of TOF

A
  • Maintain Intravascular Volume and SVR (don’t overload)

- Avoid increase in PVR (acidosis, histamine release, etc)

121
Q

What is common induction agent in TOF pts?

A

ketamine

-maintains SVR

122
Q

Decreasing SVR in TOF patients results in what?

-what considerations do we have for anesthesia regarding this?

A

-Decreasing SVR will INCREASE Right to left shunt making hypoxemia worse.

(inhalational agents, ganglionic blockers, alpha adrenergic blockers, and vasodilators all will decrease SVR)

123
Q

Is inhalation induction recommended for TOF (right to left shunts)?

explain

A
  • Not recommended
  • R to L shunting slows the uptake of INH agents and
  • accelerates IV anesthetics
  • oxygenation often improves after induction
124
Q

Treat hypercyanotic spells with:

A

IV Neo
Propranolol
Sodium Bicarb (to correct met. acidosis)
monitor for hypovolemia

125
Q

In tricuspid atresia, blood can only flow out of the RA via ____

A

PFO (or an ASD)

- a PDA or VSD is necessary for BF from the LV into pulmonary ciruclation

126
Q

cyanosis is tricuspid atresia is evident at

A

birth

127
Q

early survival in pts with tricuspid atresia is dependent on

A

Prostaglandin E1 infusion

with or w/o other palliative procedures

128
Q

Preferred surgical procedure for tricuspid atresia

A

modified Fontan Procedure

129
Q

Fontan Procedure success depends on maintaining:

A
  1. HIGH SVR

2. LOW PVR and LA pressure

130
Q
  • the aorta arises from the LV
  • Pulm Artery and Aorta are anatomically switched

Therefore deoxygenated blood returns back into systemic circulation while oxygenated blood returns back to the lungs.

This describes what CHD?

A

Transposition of the Great ARteries (TGA)

131
Q

TGA survival is only possible through:

A

mixing of de/oxygenated blood across the FO and a PDA

-presence of VSD increases mixing and reduces hypoxemia

132
Q

would you use a prostaglandin E1 infusion for a pt with TGA?

A

yes

133
Q

***TGA may occur with a VSD and pulmonic stenosis. This mimics what CHD?

  • but what affect does this obstruction have on the heart?
A
  • mimics TOF

- but the obstruction affects the LEFT ventricle, not the right (b/c the pulm valve and aorta are switched)

134
Q

in a total anomalous venous return defect; which direction is the shunt?
is blood mixing? if so, where?

A

Right to left
-mixing of de/oxygenated blood occurs at or before the RA level b/c the pulm vein drains into the SVC or IVC, Coronary sinus, or ductus venosus

135
Q

abesence of a direct connection b/w the pulmonary veins and the LA results in what CHD?

A

total anomalous venous return

136
Q

Obstruction in pulmonary venous return results in

A

severe pulmonary congestion

137
Q

A single arterial trunk supplies the pulmonary and systemic circulation in this CHD:

A

truncus arteriosus

138
Q

A truncus always overrides a VSD. This allows for

A

both ventricles to eject into it

139
Q

As PVR decreases after birth, in pts with Truncus arteriosus, pulmonary BF increases greatly. This results in:

A

Heart Failure

140
Q

what kind of shunt is truncus arteriosus?

A

right to left

mixed blood

141
Q

A Group of defects characterized by Marked underdevelopment of the Left Ventricle is this CHD:

A

hypoplastic Left Heart Syndrome (HLHS)

142
Q

Major Characteristics of Hypoplastic Left Heart Syndrome include:

A
  • RV is Main Pumping chamber for both systemic and pulmonary circulations
  • LV hypoplasia
  • MV hypoplasia
  • Aortic (ascending) hypoplasia
  • AV atresia
143
Q

In HLHS, systemic blood flow is dependent on

A

a PDA

Prostaglandin E1 infusion needed to maintain PDA

144
Q

What kind of shunt is HLHS?

A

right to left

145
Q

this is nearly always a delayed complication of acute rheumatic fever:

A

mitral stenosis

146
Q

Mitral stenosis is more often fe/male?

A

2/3 pts are female

147
Q

MS is less than 50% isolated as a sole complication.

What complications are often seen in conjunction with MS?

A 
MR
Aortic Valve (stenosis or regurg)
148
Q

MS is a progressive mechanical obstruction to LV diastolic filling resulting in

A

increased LA volume and pressure

149
Q

with MStenosis, the LA dilates. If Pulmonary pressure > 25mmHg what happens?

A

PVR increases –> Pulm HTN

150
Q

an enlarged left Atrium may apply pressure to surrounding areas. In Mitral Stenosis, this atrial enlargement may present as:

A

Left RLN injury = Hoarseness

151
Q

Mitral stenosis effect on a-wave

A

Prominent A-wave on PCWP

152
Q 
Mitral Stenosis Goals:
-HR:
Rhythm:
Preload:
Afterload:
Contractility:
A

-HR: 60-90; avoid Tachy and large increase in CO
Rhythm: NSR; controlled a.fib if present
Preload: MAINTAIN. avoid hypovolemia AND Overload
Afterload: MAINTAIN SVR - move forward
Contractility: Maintain

153
Q

Anesthesia considerations for Mitral Stenosis:

A

Anesthesia:

  • Epidural over Spinal; vasodilation sensitivity
  • AVOID Pancuronium (tachycardia)
  • Tx Tachy with Opioid or Beta Blocker (Esmolol)
  • Control A.fib with CCB, digoxin
  • Neo pref. to tx BP d/t lack of beta agonist activity (avoid ↑HR)
154
Q

Goal for HR in Mitral stenosis:

A

avoid tachycardia!

155
Q

reduction of forward SV due to backward flow of blood into the LA during systole is known as:

A

mitral regurgitation

156
Q

chronic MR is usually due to

A

rheumatic fever

157
Q

What phase of cardiac cycle is the backward flow of blood in MR (diastole or systole)?

A

Systole

158
Q

MV regurgitation is eccentric or concentric?

A

eccentric

159
Q

MR reduces _______, but may enhance _____.

A

reduces LV Afterload

may enhance Contractility

160
Q

With time, MR causes eccentric LV hypertrophy progressively impairing what?

A

contractility

  • reflected by decreased EF <50%
  • regurgitant volume exceeding the forward SV
161
Q 
Mitral Regurg Goals:
-HR:
Rhythm:
Preload:
Afterload:
Contractility:
A 
Mitral Regurg. Goals:
-HR: Increase (brady can increase AL) 80-100bpm
Rhythm: NSR
Preload: maintain
Afterload: reduce
Contractility: Maintain / Increase
162
Q

describe the type of murmur heard with MR:

A

blowing murmur
best heard at apex
radiates to axilla

163
Q

**Symptomatic progression of MR

Regurgitant Factor % and symptoms =

A

Regurgitant Factors < 30% = mild symptoms
Regurgitant Factors 30-60% = moderate symptoms
Regurgitant Factors > 60% = severe symptoms

164
Q

**When is surgical repair indicated for MR?

A

when EF is < 0.6 or before the LV ESD is 45 mm or greater

165
Q

Anesthetic considerations for MR:

A
  • reduce SVR with agents (pts generally do well)
  • spinal/epidural well tolerated
  • Avoid bradycardia
166
Q

Can pt with MR receive spinal/epidural?

A

yes - well tolerated

AVOID bradycardia!!

167
Q

In cases of moderate to severe MR (30-60% or >60%) what anesthetic changes are required?

A

opioid based anesthesia
- pancuronium (tachy) + fentanyl

avoid bradycardia

168
Q

**Inotropes increase contractility, vasodilators decrease afterload.

These changes allow for ….

A

improved forward flow

169
Q

Mitral Valve Prolapse is characterized by:

A

mid systolic click

with or w/o late apical systolic murmur

170
Q

What disorder is highly associated with MV Prolapse?

A

Marfan Syndrome (connective tissue d/o)

171
Q

How do you dx MVP?

A

ECHO

172
Q

MVP often has some element of what additional defect?

A

Mitral regurg.

173
Q

When are women more susceptible to MVP?

A

pregnancy

-accommodation of increased volume

174
Q

What worsens MVP?

A

DECREASED ventricular volume (PRELOAD)

stay hydrated!

175
Q

most common dysrhythmias associated with MVP?

A

PSVT

176
Q

Anesthetic considerations for MVP include:

A

*MOST ARE ASYMPTOMATIC AND DO NOT REQUIRE SPECIAL CARE**

  • ABX prophylaxis (if systolic murmur greater risk of infective endocarditis)
  • beta blocker for V. dysrhythmias
  • MR caused by MVP is worsened by decreased Ventricular size:
  • — avoid hypovolemia and decreased afterload
177
Q

what vasopressor would you use in case of MVP?

A

alpha - adrenergic (NEO) is preferable to beta-adrenergic (ephedrine)

178
Q

*abnormalities of aortic valve associated with Aortic Regurg are usually

A

congenital

179
Q

Abnormalities affected the ascending aorta cause regurg. by dilating the aortic annulus. This can be caused by:

A
  • syphilis
  • systic medical necrosis (with or w/o marfan syndrome)
  • ankylosing spondylitis
  • RA
180
Q

Acute AR follows:

A

trauma
infection (endocarditis)
aortic dissection

“TIA”

181
Q

regurg. volume depends on:

A

HR!! (diastolic time)
-diastolic pressure gradient across the AV

a slow HR increases regurg d/t increased diastolic time

182
Q

what type of hypertrophy is Aortic Regurgitation?

A

Eccentric (volume overload)

183
Q

Patients with this HD have the largest EDV of any heart disease

A

Aortic Regurgitation

-the massively dilated heart is often referred to as “Cor bovinum” (massive hypertrophy of LV)

184
Q

why is angina present in AR in the absence of CAD?

A
  1. increased myocardial O2 demand
  2. reduction in blood supply d/t low Diastolic pressure

*Coronaries are MOSTLY perfused during diastole!

185
Q

what happens over time to heart with AR?

A
  • Ventricular function deteriorates (late in dx)

- LV EDP and ESV INCREASE (may lead to pulm congestion)

186
Q

Chronic AR usually presents as:

other symptoms would include?

A

-CHF! (DOE, Weakness, orthopnea)

    • Diastolic murmur (Left sternal notch)
    • Widened pulse pressure
    • Decreased Diastolic pressure
    • Bounding peripheral pulses
    • Mitral regurg.
187
Q 
Aortic Regurg Goals:
-HR:
Rhythm:
Preload:
Afterload:
Contractility:
A

-HR: Increase / normal 80-100bpm; avoid Brady (increases regurg. vol)
Rhythm: SR
Preload: Maintain; increase to max fwd CO and BP
Afterload: Decrease (keep moving fwd)
Contractility: Maintain

188
Q

If a vasopressor is needed in AR, which would you use?

A

Ephedrine

prevent brady = neo can cause reflex brady

189
Q

what side of the heart is Tricuspid Regurgitation?

A

right side

190
Q

***clinically significant TR is most commonly due to dilation of RV from

A

Pulmonary HTN associated with chronic LVF

191
Q

TR can also result from:

A
  • infective endocarditis (injecting drug abusers)
  • Rheumatic Fever
  • Carcinoid syndrom
  • Chest trauma
  • Ebstein’s anomaly
192
Q

Describe Ebstein’s Anomaly

A

downward displacement of the valve b/c of abnormal attachment of the valve leaflets

” a rare, congenital heart defect. In patients with Ebstein’s anomaly, the valve between the chambers on the right side of the heart (the tricuspid valve) does not close correctly.”

193
Q

Ebstein’s anomaly is often linked to what condition?

A

Wolff-Parkinson-White syndrome

194
Q 
Tricuspid Regurg Goals:
-HR:
Rhythm:
Preload:
Afterload:
Contractility:
A
  • HR: Maintain
  • Rhythm: NSR
  • Preload: Maintain. avoid hypovolemia
  • Afterload: Maintain. (avoid increasing)
  • Contractility: Maintain
195
Q

In what condition would PEEP and high mean airway pressures are UNdesirable?

Why?

A

Tricuspid Regurg.

- reduces venous return and increase RV afterload

196
Q

What anesthetic gas should be administered with caution (if at all) in patients with Tricuspid regurgitation?

A

N2O

Fall'20 Advanced Principles II (7 decks)

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