Mitral Stenosis

Question 1

Causes of mitral stenosis?

Answer 1

Aging calcification
Endocarditis
Rheumatic fever

Question 2

Symptoms of mitral stenosis?

Answer 2

Diastolic murmur
Dyspnea
Orthopnea
Fatigue

Question 3

What conditions are associated with mitral stenosis?

Answer 3

Anemia
Pregnancy
Stress

Question 4

What is the primary pathophysiological problem with mitral stenosis?

Answer 4

Obstruction to LV filling

Question 5

What problems can occur due to this under loaded LV from obstruction to filling with MS?

Answer 5

decrease in preload > under perfusion of organs
fatigue
venous stasis, thrombus, emboli

Question 6

What pressure gradient is considered severe mitral stenosis?

Answer 6

Mean gradient higher than 10 mmHg

Question 7

What are the secondary compensatory mechanisms with MS?

Answer 7

Increased blood volume
Left atrial overload
Increased LA pressure maintains LV filling and SV at rest and normal HR

Question 8

What are the consequences of the compensatory mechanisms of MS?

Answer 8

Left atrial enlargement

Question 9

What can occur due to left atrial enlargement with MS?

Answer 9

Biphasic P waves
Atrial dysrhythmias
Blood stasis, thrombus, emboli

Question 10

With volume increasing in the LA with MS, what clinical implications does this have?

Answer 10

Pulmonary hypertension from increased PVR

-leads to RV failure, pulmonary congestion, peripheral edema and ascites

Question 11

The impaired LV filling that occurs with MS requires what?

Answer 11

Atrial kick

Adequate diastolic fill time

Question 12

How is LV function with MS?

Answer 12

LV function is preserved

Question 13

What are the anesthetic HR goals with MS?

Answer 13

Avoid tachycardia

-decreased diastolic time impairs LV filling

Question 14

What are the anesthetic SVR goals with MS?

Answer 14

Maintain SVR

-decreases in SVR associated with increased HR

Question 15

What else can be avoided to help with anesthetic goals with MS?

Answer 15

Avoid increases in PVR

-they are already prone to pulmonary HTN

Question 16

What is the number 1 anesthetic goal with MS?

Answer 16

Avoid tachycardia

Question 17

What medications are important for MS patients?

Answer 17

Digoxin
-continue to maintain SR and control HR
Anticoagulant (Coumadin is common) 
- +/- based on risk/benefit
Consider endocarditis prophylaxis

Question 18

What type of dysrhythmia is common with MS?

Answer 18

Atrial dysrhythmias

Question 19

What can be used to decrease HR with MS patients?

Answer 19

Digoxin
BB
CCB

Question 20

What INR is therapeutic?

Answer 20

2.5-3.0

Question 21

Why could anxiety be problematic with MS?

Answer 21

It increases HR

-preop anxiolytics

Question 22

What are MS patients sensitive to when it comes to drug effects?

Answer 22

Respiratory depressants

Question 23

What about induction meds with MS?

Answer 23

No ketamine

Question 24

Muscle relaxants with MS?

Answer 24

Ensure minimal effects on HR and SVR

Question 25

What about anesthetic gases with MS?

Answer 25

ISO, SEVO, DES are fine

Avoid Nitrous because it increases PVR

Question 26

What about regional with MS?

Answer 26

Anticoagulation issues

SVR effects

Question 27

What monitor could help if MS is severe?

Answer 27

CVP

-monitor pulmonary HTN, RV failure

Question 28

Describe the use of a PAC with MS

Answer 28

Relationship of PCWP and LVEDP altered by mitral dysfunction
-PCWP reflects LA pressure

She calls it not useful with MS