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NUNA 684 Advanced Pathophysiology > Exam II: Valvular Disease > Flashcards

Exam II: Valvular Disease Flashcards

1
Q

Cardiac output definition

A

Amount of blood that is ejected from the LV during 1 minute

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2
Q

Average CO

A

5 L/min

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3
Q

Average CI

A

2.5 L/min/m2

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4
Q

CO determined by ____ (__-__ bpm), and ___ ___ - the amount of blood ejected from the ____ with each beat (__mL)

A

HR (70-80 bpm)
Stroke volume
LV
70 mL

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5
Q

Preload - effective tension of the blood on the ____ or the wall tension at the end of ____

A

Ventricle
Diastole

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6
Q

Preload (passive) - flow from ___ to ____ during ____

A

Atria to ventricle
Diastole

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7
Q

Preload (active) - volume contributed by the ___ ____

A

Atrial kick

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8
Q

Frank-Starling Law:

A

The greater the wall tension, the greater the myocardial contractility until over distention of the myocardium occurs

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9
Q

Preload measurement: ____ or ____

A

PCWP or PADP

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10
Q

afterload - the ____ ____ that the myocardium needs to overcome to eject the ___ (open the ___ or ____ valves)

A

wall tension
CO
aortic or pulmonic

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11
Q

afterload is the pressure within the ____ during peak ____

A

LV
systole

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12
Q

afterload is affected by _____ and _____ compliance - ____ and ____, if only ____ is taken into account, ventricular wall tension is not considered

A

chamber and vasculature
SVR and MAP
SVR

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13
Q

_____ _____ - the inotropic state that is independent of preload and/or afterload

A

myocardial contractility

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14
Q

myocardial contractility - rate of ____ changes over time (__/__)

A

pressure
(dP/dt)

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15
Q

myocardial contractility - velocity of contraction developed by ____ ____

A

cardiac muscle

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16
Q

myocardial contractility - ____-____ loops

A

pressure-volume

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17
Q

myocardial contractility - clinically wide range so comparisons between pts is ____ _____, look at changes in _____ over time for a single patient

A

not reasonable
contractility

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18
Q

Pressure-volume loops: denotes ______ pressure and volumes changes during the ____ ____

A

intraventricular
cardiac cycle

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19
Q

Pressure-volume loops: simultaneously measure _____ _____ and the resultant _____

A

chamber pressures
volumes

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20
Q

Cycle
Phase I –
Phase II –
Phase III –
Phase IV –

A

Cycle
Phase I – diastolic filling
Phase II – isovolumetric contraction
Phase III – systolic ejection
Phase IV – isovolumetric relaxation

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21
Q

Pressure-volume loops - distance between vertical lines represents ____

A

SV

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22
Q

Pressure-Volume Loop - used to diagram key features of ____ during the ____ ____

A

LV
cardiac cycle

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23
Q

SV = ____-____

A

EDV - ESV

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24
Q

ejection fraction = % of ____ ejected with each _____

A

EDV
contraction

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25
Q

EF = ___/___ x 100

A

EF = SV/EDV x 100
ex: 80/120 x 100 = 60-70%

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26
Q

minimal increase pressure with ventricular filling reflects ____ character of ____ ventricle

A

elastic
compliant

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27
Q

cardiac work (pressure x volume) = total area of ____ ____ ____

A

pressure volume loop

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28
Q

pressure volume loop - greater O2 demand with ____ ____ vs ____ ____

A

pressure work (afterload) vs volume work (preload)

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29
Q

stroke work of the RV 1/7 that of the LV bc ____ much less than ____

A

PVR
SVR

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30
Q

A: end of _____
EDV = 110-150 mL

B: beginning of ____ ____

C: end of ____
ESV = 40-80 mL

D: begins ___ ____ – diastolic pressure close to 0

A

diastole
systolic ejection
systole
LV filling

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31
Q

A to B – all valves ____, no change in volume, but ____ pressure

A

closed
increased

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32
Q

B to C – stroke volume = ___-___ mL

A

60-90

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33
Q

C to D – all valves ____, no change in volume, but _____ pressure

A

closed
decreased

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34
Q

D to A – volume _____ with diastolic filling, pressure ____ only slightly - reflects elastic character of _____ ventricle

A

increases
increases
compliant

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35
Q

Changes in Preload - theory: If ___ is increased (preload), ejection of blood to same ____; increased SV, EF

A

EDV
ESV

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36
Q

Changes in Preload - theory: If EDV is decreased (preload), SV _____ as ESV is _____.

A

decreases
unchanged

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37
Q

To examine the independent effects of preload, assume that ____ ____ and ______ pressure (afterload), and _____ are held constant

A

aortic systolic
diastolic
inotropy

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38
Q

Increased preload (stretch) means increased ___, increased ___, aortic pressure, increased ____, increased ESV due to decreased velocity
[Changes in Preload – Interdependent with Afterload]

A

SV
CO
afterload

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39
Q

Decreased preload means decreased ____, decreased ____ ____, decreased ____
[Changes in Preload – Interdependent with Afterload]

A

SV
aortic pressure
ESV

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40
Q

An increase in preload (end-diastolic volume represented by red loop in figure) leads to an ____ ___ _____ ____ (width of loop) because of the Frank-Starling mechanism.
[Changes in Preload – Interdependent with Afterload]

A

increase in stroke volume

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41
Q

If aortic pressure is increased, SV, EF are ____ and ESV is _____.
[Changes in Afterload - theory]

A

smaller
increased

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42
Q

If aortic pressure is decreased, SV, EF are ____ and ESV is _____.
[Changes in Afterload - theory]

A

increased
decreased

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43
Q

Increased SVR leads to decreased ___, increased ____ – this leads to increased ____ (preload), which increases contraction to offset change in SV (healthy)
[Changes in Afterload – Interdependent with preload]

A

SV
ESV
EDV

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44
Q

Decreased aortic pressure, SV _____, ESV ______, EDV ______ only slightly
[Changes in Afterload – Interdependent with preload]

A

increases
decreases
decreases

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45
Q

Two pressure-volume loops representing contractions with ____ ____ fractions and ____ _____, but markedly different mechanical work

A

identical ejection
stroke volumes

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46
Q

Greater myocardial work due to higher afterload required to maintain ___ and ___

A

EF
SV

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47
Q

Increased _____ of _____ _____ leads to increased SV, EF and decreased ESV.
[Changes in Inotropy]

A

velocity of fiber shortening

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48
Q

Decreased pressure at a given LV volume (velocity) leads to decreased ___, ____ and increased ____.
[Changes in Inotropy]

A

SV
EF
ESV

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49
Q

In PV loop diagrams, increased ______ increases the slope of the end-systolic pressure-volume relationship (ESPVR; red dash line in top panel), which permits the ventricle to generate ____ _____ at a given LV volume. Decreasing _____ has the opposite effects; namely, increased end-systolic volume and decreased stroke volume and ejection fraction (bottom panel of figure).
[Changes in Inotropy]

A

inotropy
more pressure
inotropy

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50
Q

Increased inotropy leads to increased _____ at a given ___ _____; thus increased SV, EF, and decreased ESV. Then, decreased EDV. Increased CO and MAP.
[Changes in Inotropy - Interdependent with preload]

A

pressure
LV volume

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51
Q

Decreased ______ leads to increased ESV, decreased SV, EF. Then, increased ____.
[Changes in Inotropy - Interdependent with preload]

A

inotropy
EDV

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52
Q

Increased inotropy (red loop in figure) increases the ____ and shifts the end-systolic pressure-volume relationship (ESPVR) to the ____, which permits the ventricle to generate more pressure at a given LV volume.
[Changes in Inotropy - Interdependent with preload]

A

slope
left

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53
Q

Exercise leads to increased _____ _____ (increase in EDV); sympathetic stimulation increases ______ – decreased ESV.
[Changes in Preload, Afterload, Inotropy during Exercise]

A

venous return
inotropy

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54
Q

with exercise, Combined, small _____ in EDV, large _____ in ESV, _____ SV, EF.
______ BP
[Changes in Preload, Afterload, Inotropy during Exercise]

A

increase
decrease
increased
increased

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55
Q

Exercise is a good example of how simultaneous changes in preload, afterload and inotropy affect ______ ______ _____ ______ (red loop in figure). During whole body exercise (e.g., running, bicycling) increased venous return to the heart generally causes a small increase in end-diastolic volume.
[Changes in Preload, Afterload, Inotropy during Exercise]

A

ventricular pressures and volumes

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56
Q

Valvular Disease - Most commonly affected (2)

A

mitral and aortic

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57
Q

primary valvular dysfunction - valve leaflets or ____ damage to ____ ____ to cause dysfunction

A

structural
fibrous annulus

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58
Q

Secondary valvular dysfunction – no damage to valve or supporting structure, but dysfunction due to other pathology: ventricular dilation (___), retrograde aortic dissection (___), papillary muscle damage/infarction (___)

A

MR
AR
MR

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59
Q

left side of heart is ____ pressure side

A

higher

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60
Q

Stenosis – _____ of orifice (____ outflow)

A

narrowing
fixed

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61
Q

Stenosis: pressure overload - _____ hypertrophy

A

concentric

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62
Q

Stenosis: compensation - adding _____ in parallel

A

sacromeres

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63
Q

Stenosis: _____ wall, decreased ____ of chamber

A

thicker
radius

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64
Q

Insufficiency or regurgitation – flow _____, instead of ____/____ direction

A

retrograde
forward/one

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65
Q

Insufficiency or regurgitation: Volume overload – _____ hypertrophy
During ____, __ sources of blood entering

A

eccentric
diastole
2

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66
Q

Insufficiency or regurgitation: Compensation – adding _____ in series

A

sacromeres

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67
Q

Insufficiency or regurgitation: _____ chamber, ____ radius

A

dilated
increased

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68
Q

____ – both stenosis with insufficiency or insufficiency with stenosis (symptoms will be _____ for one over the other)

A

Mixed
dominant

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69
Q

Sympathetic stimulation – may see _____, ______, ____ _____

A

anxiety, diaphoresis, resting tachycardia

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70
Q

pre-op eval: severity of disease (3)

A
  • murmur
  • acute v. chronic
  • compensatory mechanisms (sympathetic stimulation, ventricular hypertrophy - angina due to increased demand even in the absence of CAD)
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71
Q

pre-op eval: myocardial contractility - _______ and symptoms ____, _____, _____

A

CHF
basilar chest rales, jugular venous distention, S3 sound

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72
Q

pre-op eval: major _____ disease

A

organ

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73
Q

Murmurs (4) and acronyms to remember them

A

Mitral Stenosis
M.S.D.A. – Diastolic, Apex/Axilla
Mitral Regurgitation
M.R.S.A. – Systolic, Apex/Axilla
Aortic Stenosis
A.S.S.S. – Systolic, Sternal Rt
Aortic Regurgitation
A.R.D.S. – Diastolic, Sternal Rt

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74
Q

Diagnostic tests: EKG
Notched p wave –
Axis deviation –
Dysrhythmias –

A

Notched p wave – LA enlargement
Axis deviation – RV or LV hypertrophy
Dysrhythmias – atrial fib

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75
Q

Diagnostic tests: X-ray
looking for cardiomegaly - ____ of internal width of thoracic cage
valvular _____ and _____ in lungs

A

> 50%
calcifications and markings

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76
Q

Diagnostic tests: ECHO
looking for _____ measurements, valve ____, _____ _____ across a valve, degree of ______ flow

A

cavity
area
pressure gradients
regurgitant

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77
Q

Mitral Stenosis (MS) - most common cause _____ _____

A

rheumatic fever

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78
Q

Mitral Stenosis (MS): ____ progression, may become symptomatic after more than __-__ ___ from incidence of rheumatic fever

A

slow
20-30 years

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79
Q

Mitral Stenosis (MS) occurs more in _____

A

females

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80
Q

Mitral Stenosis (MS) symptoms (3)

A
  • dyspnea on exertion
  • orthopnea
  • paroxysmal nocturnal dyspnea r/t increased LA pressures
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81
Q

Mitral Stenosis (MS): ______ of valvular leaflets and subvalvular apparatus, commissural fusion, and ______ of annulus and leaflets

A

thickening
calcification

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82
Q

Mitral Stenosis (MS): Symptoms develop when mitral area _______ to less than ____ cm2 (considered severe < ___cm2)

A

decreases
1.5
1

83
Q

Mitral Stenosis (MS): obstruction to ____ _____ filling

A

LV diastolic

84
Q

Mitral Stenosis (MS): increase in LA _____ and _____. Backs up to cause increase in ______ _____ pressure.

A

pressure and volume
pulmonary venous

85
Q

Mitral Stenosis (MS): ____, ____, ____ failure may develop. ____ function is preserved - usually normal.

A

CHF, PHTN, RV
LV

86
Q

Mitral Stenosis (MS): ________ pressure – severe MS >10 mm Hg (normal ____mm Hg)

A

transvalvular
< 5

87
Q

Mitral Stenosis (MS): Broad notched P waves due to ____ _____

A

LA enlargement

88
Q

Mitral Stenosis (MS): stasis of blood in distended LA increases risk of _____ ______

A

systemic thromboembolism

89
Q

atrial fib occurs in ____ of severe ____ ____ patients

A

1/3
mitral stenosis

90
Q

Mitral Stenosis (MS): may hear opening ____ early in _____ - rumbling diastolic heart murmur

A

snap
diastole

91
Q

MS treatment: (4)

A
  • diuretics
  • HR control of Afib with digoxin, beta blockers, CCBs or a combo
  • anticoagulation
  • surgical repair
92
Q

MS - AVOID ______ - causes increased LAP due to decreased LV filling

A

tachycardia

93
Q

MS - stasis of blood in ____, esp with _____

94
Q

MS surgical repair is necessary when _____ _____ and ____ worsening and may include percutaneous ____ _____, surgical ______, valve reconstruction or valve _____

A

pulmonary HTN and symptoms
balloon valvotomy
commissurotomy
replacement

95
Q

MS - stasis of blood, risk of embolic stroke is ___-___ per year

96
Q

Anesthetic implications - MS: avoid depression of ____ or facilitation of ___ ____

A

CO
pulm edema

97
Q

Anesthetic implications - MS: avoid _____ (avoid _____ - reflex ____)

A

tachycardia
hypotension
tachy

98
Q

Anesthetic implications - MS: avoid over _____, ______ position. Careful titration.

A

hydration
trendelenburg

99
Q

Anesthetic implications - MS: avoid sudden decrease in ____

100
Q

Anesthetic implications - MS: avoid _____ and ______ to avoid pulm HTN

A

hypoxemia and hypercarbia

101
Q

Anesthetic implications - MS: avoid postop pain - _____ (avoid hypoventilation with subsequent ____ _____)

A

tachycardia
resp acidosis

102
Q

Anesthetic implications - MS: anxiolytics - be careful about preop _____ _____ - may be sensitive to vent ______ effects

A

sedative effects
depressant

103
Q

Anesthetic implications - MS: No ______

A

anticholinergics

104
Q

Anesthetic implications - MS: be careful of ______ if planning neuraxial block

A

anticoagulation

105
Q

Anesthetic implications - MS: _____ is better for slower onset

106
Q

Anesthetic implications - MS: avoid ____ - causes increased HR

107
Q

Anesthetic implications - MS: avoid ____ _____ - decreased SVR

A

histamine release

108
Q

Anesthetic implications - MS: OPTIMIZE _____ _____ FILLING

A

DIASTOLIC LV

109
Q

Anesthetic implications - MS: if hypotensive, treat with _____ or ______ to increase BP without increasing HR

A

phenylephrine or vasopressin

110
Q

Anesthetic implications - MS: Goal (5)

A
  • decreased to normal HR
  • NSR
  • normal afterload
  • normal to increased preload (titrate carefully not to overhydrate)
  • avoid increases in PVR
111
Q

MS - underfilled ____ with decerased ____

112
Q

Mitral Regurgitation (MR): usually r/t _____

113
Q

Mitral Regurgitation (MR): may be due to ____, _____ muscle dysfunction, rupture of _____ _____

A

IHD
papillary
chordae tendinae

114
Q

Mitral Regurgitation (MR):

115
Q

Mitral Regurgitation (MR): can be seen with MVP, _____, ____, ____, cardiomyopathy, systemic ____ _____, ankylosing spondylitis, and _____ syndrome.

A

endocarditis, trauma, LVH
lupus erythematous
carcinoid

116
Q

Mitral Regurgitation (MR): ____ _____ of LA compensated for by vasodilation to promote _____ flow

A

volume overload
forward

117
Q

Mitral Regurgitation (MR): MR occurs during ____ (unlike ____) from the LV back into the ____ which becomes dilated

A

systole
AR
LA

118
Q

Mitral Regurgitation (MR): _____ is the leading cause of functional MR

119
Q

Mitral Regurgitation (MR): is one of the ____ ____ ____ forms of valvular heart disease in the elderly

A

two most common

120
Q

Mitral Regurgitation (MR) patho: a portion of the ____ ____ is allowed to flow backward into the _____

A

LV volume
LA

121
Q

Mitral Regurgitation (MR) patho: leads to ____ _____ ____ and potentially ____ ____ - enlargement, not increased pressure in LA

A

LA volume overload
pulmonary congestion

122
Q

Mitral Regurgitation (MR) patho: ___ ______ - possibly without symptoms. Increased ____.

A

LV hypertrophy
EDV

123
Q

Mitral Regurgitation (MR) patho: when the fraction of SV which is _____ is more than ____, this is considered severe MR

A

regurgitant
0.6

124
Q

Mitral Regurgitation (MR): determinants of fraction that flows backwards are (3)

A
  1. size of the mitral valve orifice
  2. heart rate (duration of ejection)
  3. pressure gradients across the mitral valve
125
Q

Treatment - MR: (3)

A
  1. valve replacement
  2. ACEIs, non-selective beta blockers (carvedilol) to decrease SVR
  3. biventricular pacing
126
Q

MR valve replacement - symptomatic patients should undergo surgery even if ___ is ____

A

EF is normal

127
Q

MR valve replacement - asymptomatic patients with chronic MR don’t _____ from _____ ____ - _____ MR patients do

A

benefit
medical management
acute

128
Q

MR valve replacement - ______ device, high-risk, percutaneous

129
Q

______ - non-selective beta blocker with alpha 1 blocking effect

A

carvedilol

130
Q

Anesthesia Implications - MR: prevent ______ (want normal, slightly increased ___)

A

bradycardia
HR

131
Q

Anesthesia Implications - MR: prevent increase in ____

132
Q

Anesthesia Implications - MR: minimize ______ _______

A

myocardial depression

133
Q

Anesthesia Implications - MR: monitor ______ flow. ____ ____ on PAC. TEE.

A

regurgitant
V wave

134
Q

Anesthesia Implications - MR: GOAL improve forward ____ ____ _____ and decrease portion moving backwards, ____, decrease afterload, normal to increased _____ (avoid rapid volume expansion)

A

LV stroke volume
NSR
preload

135
Q

Anesthesia Implications - MR: ______, _____, _______

A

FASTER, FULLER, FORWARD

136
Q

Anesthesia Implications - MR: Bradycardia leads to volume overload of LV – beware of ____ induced bradycardia – can use _____, but be careful to avoid bradycardia

A

opioid
opioids

137
Q

Anesthesia Implications - MR: Increased afterload leads to _______ of LV – avoid agents that increase ____

A

decompensation
SVR

138
Q

Anesthesia Implications - MR: Decreased SVR related to _____ is beneficial for these patients

139
Q

Anesthesia Implications - MR: ______ are good to decrease SVR, but be careful about myocardial depression

140
Q

Anesthesia Implications - MR: Monitoring
Asymptomatic – _______
Severe MR – consider ____

A

Asymptomatic – noninvasive
Severe MR – consider PA cath – MR produces v waves on PCWP waveform – changes in size of v wave might help with trending on fluids/management.

141
Q

Anesthesia Implications - MR: ____ is good

A

pancuronium

142
Q

Mitral Valve Prolapse: The movement of ___ or ____ leaflets of the mitral valve back into the LA during ____. May be with or without _____.

A

one or both
systole
regurgitation

143
Q

Mitral Valve Prolapse: ____ ____ valvular disorder __-__, particularly in young _____

A

most common
2-3%
women

144
Q

Mitral Valve Prolapse: usually ____, but can lead to (5)

A

benign
1. emboli
2. infective endocarditis
3. MR
4. dysrhythmias
5. sudden death

145
Q

Mitral Valve Prolapse: ECHO - prolapse of valve ___ mm above mitral annulus

A

> or equal to 2 mm

146
Q

Mitral Valve Prolapse: mid systolic ____ and late systolic ____

A

click
murmur

147
Q

Mitral Valve Prolapse: Primary, anatomic form – redundant, thickened leaflets – typically occurs with ____ _____ disorders such as _____, systemic ______ ______ and in elderly men

A

connective tissue
Marfan’s
lupus erythematosus

148
Q

Mitral Valve Prolapse: Normal variant (functional) form – mild _____ and normal appearing _____ – risk similar to general population

A

bowing
leaflets

149
Q

MVP symptoms (6)

A
  • anxiety
  • orthostatic hypotension
  • palpitations
  • dyspnea
  • fatigue
  • atypical chest pain
150
Q

MVP may include arrhythmias ____ or _____ - both treatable with ____ _____

A

SVT or ventricular
beta blockers

151
Q

MVP - most have normal ___ ____

A

LV function

152
Q

MVP - a larger ventricle will have less ____ than a smaller ventricle - factors that affect ventricular volume and contraction have an impact on the ____ of _____

A

prolapse
quantity of prolapse

153
Q

Anesthetic considerations - MVP: decrease LV emptying and increase ___ ____

154
Q

Anesthetic considerations - MVP: Avoid (3)

A
  1. sympathetic activity
  2. decreases in SVR
  3. upright position
155
Q

Anesthetic considerations - MVP: anticipate dysrhythmias, treat with _____ and ____ ____

A

lidocaine
beta blockers

156
Q

Anesthetic considerations - MVP: use _____ to maintain SVR

A

phenylephrine

157
Q

Anesthetic considerations - MVP: want to avoid ____ ____ by more efficient emptying

A

decreased size

158
Q

Anesthetic considerations - MVP: want to decrease emptying - decrease ____ and increase _____, _____ loading

A

contractility
volume
volume

159
Q

Anesthetic considerations - MVP: want _____, pharmacologic decreased inotropic and volume

A

vasoconstriction

160
Q

Anesthetic considerations - MVP: goals (5)

A
  1. maintain or increase preload
  2. maintain afterload
  3. maintain contractility - but dont increase it
  4. maintain HR
  5. maintain NSR
161
Q

Anesthetic considerations - MVP: _____ prophylaxis, potential _____

A

antibiotic
endocarditis

162
Q

Anesthetic considerations - MVP: if MR is present, anesthetic considerations follow those outlines for ____

163
Q

Aortic Stenosis (AS): commonly seen and is seen with ____

164
Q

Aortic Stenosis (AS): etiology - degeneration and ______ (elderly), _____ instead of ______ valve (__-__ yrs old)

A

calcification
bicuspid
tricuspic
30-50

165
Q

Aortic Stenosis (AS) patho: Decrease ____ ____ _____ forces an increase in LV pressure to maintain stroke volume (transvalvular gradient of ___ mm Hg)

A

aortic valve opening
50

166
Q

Aortic Stenosis (AS) patho: Valve area < ___ cm2 is severe (normal ___-___)

A

0.8
2.5-3.5

167
Q

Aortic Stenosis (AS): Increasing incidence with population ____ ____.

A

growing older

168
Q

Aortic Stenosis (AS): Other causes might be ____ _____ and _____ ____ ____. Risk factors are similar to _____ – HTN and hypercholesterolemia.

A

infective endocarditis
rheumatic heart disease
IHD

169
Q

Aortic Stenosis (AS): May have angina without ____ due to ____ ____ ____and increase LV work

A

CAD
concentric LV hypertrophy

170
Q

Aortic Stenosis (AS): classic symptoms (3)

A
  1. angina pectoris
  2. syncope
  3. dyspnea on exertion (CHF)
171
Q

Aortic Stenosis (AS): onset of these symptoms correlate to mortality with __, __, and __ years respectively

A

5, 3 and 2

172
Q

Aortic Stenosis (AS): murmur - ____- heard best at ____ area - may radiate to neck

A

systolic
aortic

173
Q

Aortic Stenosis (AS): ____ to determine severity of stenosis - area of valve, transvalvular gradient

174
Q

Anesthetic implications - AS: maintain ____ - ___ kick

175
Q

Anesthetic implications - AS: avoid ____ and _____

A

bradycardia and tachycardia

176
Q

Anesthetic implications - AS: avoid hypo_____

A

hypotension

177
Q

Anesthetic implications - AS: carefully titrate fluid volume to maintain ____ ____ and ____ filling - _____ dependent patients

A

venous return
LV
preload

178
Q

Anesthetic implications - AS: goals - normal to slow ___, ____ (atrial kick), slight increase in ____, increased _____

A

HR
NSR
afterload
preload

179
Q

Anesthetic implications - AS: treat hypotension with ____ _____ - doesnt cause tachycardia and thus maintains diastolic filling time

A

alpha agonists

180
Q

Aortic Regurgitation (AR): incompetent valves due to ____ ____, infective _____, _____ aortic valve

A

rheumatic fever, infective endocarditis, bicuspid aortic valve

181
Q

Aortic Regurgitation (AR): damage due to (5) things

A
  • Marfan’s
  • Ehlers-Danlos
  • syphilitic aortitis
  • ankylosing spondylitis
  • psoriac arthritis
182
Q

Aortic Regurgitation (AR): acute onset - ____ ____ or _____

A

aortic dissection or endocarditis

183
Q

Aortic Regurgitation (AR): flow backwards from ____ into the ____ during diastole

184
Q

Aortic Regurgitation (AR): both ____ and ____ ____ of LV

A

pressure and volume overload

185
Q

Aortic Regurgitation (AR): degree of regurgitant flow determinants (2)

A
  1. time to flow backwards (HR)
  2. pressure gradient from aorta to LV (SVR)
186
Q

Aortic Regurgitation (AR): decreased regurgitant flow related to (2)

A
  1. tachycardia
  2. peripheral vasodilation
187
Q

Aortic Regurgitation (AR): widened ___ ____

A

pulse pressure

188
Q

Aortic Regurgitation (AR): decreased _____ pressure

189
Q

Aortic Regurgitation (AR): bounding ____

190
Q

Aortic Regurgitation (AR): acute AR - severe volume overload with LV unable to compensate leading to ____, rapid progression to ____ failure

A

ischemia
LV failure

191
Q

Aortic Regurgitation (AR): chronic AR - LV ____ _____ and LV ______

A

eccentric hypertrophy
enlargement (concentric)

192
Q

Aortic Regurgitation (AR): eccentric hypertrophy leads to increased _____ ____ _____

A

myocardial oxygen consumption

193
Q

Aortic Regurgitation (AR) treatment: decrease systolic _____ and LV ____ ____, improve LV ____ ____, vasodilators and _____ agents such as ____, _____, _____.

A

HTN
wall stress
stroke volume
inotropic
dobutamine, nifedipine, or hydralazine

194
Q

Anesthetic implications - AR

195
Q

Anesthetic implications - AR: avoid ______, shorten diastolic time to minimize _____

A

bradycardia
regurg

196
Q

Anesthetic implications - AR: avoid increase in ____, sudden increases can cause LV failure

197
Q

Anesthetic implications - AR: minimize _____ depression, consider using ____ to increase contractility

A

myocardial
inotrope

198
Q

Anesthetic implications - AR: Goals (4)

A
  • moderate increase in HR
  • NSR
  • decrease afterload
  • normal preload
199
Q

Prosthetic Heart Valves: _____ v ______

A

mechanical vs bioprosthetics

200
Q

Prosthetic Heart Valves: mechanical - durable, for ____, ______

A

young
anticoagulation

201
Q

Prosthetic Heart Valves: bioprosthesis - porcine, _____, ______. Only lasts __-___ years and for elderly, no ______

A

bovine
homografts
10-15
anticoagulation

202
Q

Prosthetic Heart Valves: intravascular ______

203
Q

Prosthetic Heart Valves: ______ prophylaxis

A

antibiotic

204
Q

Prosthetic Heart Valves: anticoagulation continued for ____ surgery, coumadin dc’d __-___ days prior to surgery - replaced with ____

A

minor
3-5
LMWH

NUNA 684 Advanced Pathophysiology (16 decks)

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