Heart Failure and Valvular Diseases (5) Flashcards
CO =
HR x SV
SV =
Preload, afterload and contractility
What do ejection fraction and cardiac output attempt to measure?
Contractility - but contractility is always affected by loading conditions.
LV hypertrophy is common in people with which conditions?
Hypertension, aortic stenosis
In patients with LV hypertrophy, which is more appropriate, inotropes or volume?
VOLUME - a stiff ventricle requires higher filling pressures to function. Vasodilators are a second choice if pt is euvolemic. Inotropes are the last choice.
What are the four risk factors associated with developing ***HF?
Smoking, Obesity, Diabetes, hypertension
***For best performance, patients with systolic CHF need ____ _____ for optimal contractility.
Volume loading.
***How can one improve contractility in a patient with sCHF?
Volume loading, lower BP and CO, IABP, inotropes
An elevated BNP is a diagnostic indicator of what?
Diastolic CHF
Myocardial edema causes universal ______ _______ in the first 3 hours after surgery.
diastolic dysfunction (heart muscle can’t relax/ventricle can’t fill.)
***How can one treat the diastolic dysfunction after cardiac surgery?
Give volume (increase preload) Lower HR (increase filling time) Prolong AV delay (if pacing is required) Diuresis and volume expansion
***hypoxemia, hypercarbia, and acidosis all (Increase/Decrease) pulmonary pressures.
INCREASE - causing R heart strain.
***What is a ventilator strategy to reduce pulmonary pressures?
hyperventilate - lowering CO2 and causing alkalosis.
Cardiopulmonary bypass causes SIRS, which leads to an (increased/decreased) PVR
Cardiopulmonary bypass causes SIRS, which leads to an increased PVR
pulmonary hypertension is associated with? (2 causes)
Left sided valvular disease (mitral stenosis/regurg) or diseases of hypoxia (ex, OSA)
difference between nitroglycerin and nitroprusside?
Nitroglycerin –> Lowers CO
NitropruSSide –> lowers SVR
What are the benefits of inhaled nitrous oxide?
selective, increases PaO2, decreases PVR, and increases CO
prostaglandins/prostacylcin analogs have what effect on the pulmonary vasculature?
pulmonary vasodilators
inotropes are not helpful in patients with which heart disease?**
diastolic dysfunction*****
Patients with Aortic stenosis are at high risk for?
Myocardial ischemia
Which dysarthria is common after mitral valve surgery?
A fib (new or recurrent)
Most common cause of mitral regurgitation?
Myxomatous degeneration
What conditions worsen MR?
LV dilation, increased SVR, aortic stenosis
Mitral valve: repair vs replace?
Bioprosthetic valves deteriorate, but allow native heart function to be preserved (EF)
Long term AC required with mechanical valves
What happens to after load after mitral valve repair?
It is increased (blood not being regurgitated into LA). Now patient may have low CO. the incompetent valve was providing compensatory mechanism.
Compliant, poorly contracting ventricle. (LV Systolic dysfunction)
SAM
SYstolic anterior motion of the mitral valve
Leaflets of the mitral valve cause a Left Ventricular Outflow Tract (LVOT) obstruction
SAM physiology (systolic anterior motion of mitral valve)
What exacerbates Sam physiology?
Reduced LV preload
Increased catecholemines
Inotropes
Decreased after load
What is the treatment for SAM?
Stable HR AND Rhythm
Maximize filling time
Volume, vasopressors
