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Cardiology - Dr Constable > Quiz 6 Valvular Heart Disease > Flashcards

Quiz 6 Valvular Heart Disease Flashcards

1
Q

At what levels can Aortic Stenosis occur?

A

Valvular
SubValvular
Supravalvular

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2
Q

What kinds of valvular stenosis can occur?

A
  1. Calcification & fibrosis of normal aortic valve (very common)
  2. Calcification & Fibrosis of congenital bicuspid AV (Higher incidence of stenosis ~ 40yrs old)
  3. Rheumatic - Uncommon since antibiotics
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3
Q

What is the normal aortic valve area?

A

2-4 cm2

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4
Q

In Severe aortic stenosis, what might the valve area be?

A

< 1 cm2

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5
Q

What is the normal LV mean peak gradient?

A

> 50 mmHg

** In severe AS, PG can be very low

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6
Q

What two factors can be used to judge the degree of stenosis?

A

Pressure

Valve area

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7
Q

Increased Pressure will lead to concentric or eccentric LVH?

A

Concentric

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8
Q

Increased Volume will lead to concentric or eccentric LVH?

A

Eccentric

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9
Q

Why is keeping a pt in SR so important for a pt with severe Aortic Stenosis?

A

SR is crucial to keep atrial kick. Atrial kick contributes up to 20% of ventricular filling in a normal heart and up to 40% in an ailing heart. Avoid A-fib and cardiovert early for acute changes

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10
Q

Should you try and keep a pt with AS slightly tachycardic?

A

No. Optimal HR is 60-80.

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11
Q

Why is tachycardia/Bradycardia bad for pts with stenotic lesions?

A

Tachy - decreased diastolic filling time leads to ischemia

Brady - leads to low CO due to fixed stroke volume

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12
Q

How should you treat hypotension for a pt with AS, Phenylephrine or Ephedrine?

A

Phenylephrine - alpha agonist effect will cause vasoconstriction, increase SVR and BP. Ephedrine would not be best due to beta 1 effects (increased HR).
**Can also use Norepi

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13
Q

Can placing a pt with AS in Trendelenburg be beneficial if pt is hypotensive?

A

yes. Can raise BP by 20 mmHg

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14
Q

A pt with AS has low preload and tachycardic. Should they get a spinal or epidural for the their case?

A

Neither - can cause vasodilation of Lower extremities and decrease SVR and BP.

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15
Q

Should you avoid benzos in management of AS?

A

No. for frail or elderly, can give smaller dose or none at all

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16
Q

When you are taking a pt with AS back to the OR, is it best to have an Arterial line pre-induction or can you wait until post-induction?

A

Pre-induction is best

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17
Q

Besides an Arterial line for a pt with AS, what other monitoring equip should this pt have?

A

CVP, PAC, TEE

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18
Q

Why is Systolic Anterior Motion with LVH a concern?

A

If LV is underfilled, MV can come down and touch septal wall of hypertrophied LV - obstructing outflow

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19
Q

How do you treat a pt with LVH and SAM?

A

Fluid Volume and Beta Blockers

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20
Q

A pt with acute Aortic regurgitation, will they have dilated LV?

A

No. will lead to increased LVEDP + LVEDV –> acute pulmonary edema

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21
Q

A pt with acute aortic regurg, could this be emergent?

A

yes and surgery is often required.

** Treat with inotrope and vasodilator (Epi + nipride or milrinone)

22
Q

What is the 4 “F’s” for a regurgitant lesion?

A

Fast, Forward and Full

Just kidding, there’s only 3 F’s.

23
Q

What heart rate is optimal for aortic regurg?

A

slightly tachy - 90 bpm

24
Q

What medication is preferred for treating high afterload in a pt with AR?

A

Sodium nitroprusside

25
Q

Should an intra aortic balloon pump be used in a pt with Aortic Regurg?

A

No, contraindicated

26
Q

What medications would be beneficial for RSI in a pt with acute aortic regurg?

A

Ketamine and Succ

27
Q

What are the Triad of Symptoms related to Aortic Stenosis and life expectancy?

A

Angina - 5yrs from onset
Syncope - 3-4 yrs
CHF - 1-2 yrs

28
Q

What is the most common congenital reason for Aortic Stenosis?

A

Bicuspid aortic valve

29
Q

What is the most common acquired reason for aortic stenosis?

A

senile followed by rheumatic

30
Q

What is the most common cause of Mitral Stenosis?

A

Rheumatic heart disease

31
Q

What are some of the signs of MS?

A

Fatigue, CP, palp, SOB, paroxysmal nocturnal dyspnea, pulm edema, hemoptysis, hoarseness due to compression of RLN by distended left atrium and enlarged pulm artery

32
Q

When would you consider doing surgery on a pt with MS?

A

When their mitral valve area is < 1 cm2 with NYHA class III or IV dyspnea

33
Q

With all stenosis, what are 2 things you would want to maintain?

A

Sinus rhythm and normal HR (60-80)

34
Q

What are some things you would want to avoid in a pt with MS?

A 
Hypercarbia
Acidosis
Hypothermia
SNS activation
Hypoxia
35
Q

If a pt has pulm HTN, what could you do to do?

A

Start supplemental oxygen

36
Q

How could you control the HR for a pt with MS?

A

B-blockers, Dig, Ca-Channel blockers, amiodarone

37
Q

What is the single most useful drug to use on pts with severe MS?

A

Esmolol 10-20mg bolus, 50-100 mcg/kg/min

**even with CHF and Pulm Edema

38
Q

What anesthetic gas should be avoided on a pt with Pulm HTN?

A

N2O

39
Q

What NDMR should be avoided on the pt with MS?

A

Pancuronium - can cause tachycardia

40
Q

Why would a pt with Mitral regurg be more likely to have atrial arrhythmias?

A

Due to dilated LA. LA can be massively dilated

41
Q

Volume overload in a pt with mitral regurg can lead to __________ and ___________ enlargement

A

LV and LA

42
Q

What 3 factors can determine the severity of Mitral Regurg?

A

Pressure gradient against LA and LV
Size of regurgitant orifice
Duration of ventricular systole

43
Q

Why would you want to use vasodilators like NTG or nitroprusside for regurgitant lesions?

A

Helps decrease SVR and keeps forward flow of blood

44
Q

What can be unmasked after repair of MR?

A

LV dysfunction may have been masked by its decreased ability to offload into the LA

45
Q

What is a primary reason for Tricuspid regurg?

A

rheumatic, inf endocarditis, carcinoid, Epstein Bar, trauma

46
Q

In a pt with Tricuspid regurg and R heart failure, what other problems may be manifested?

A

hepatomegaly

Ascites

47
Q

Be sure to look through slides at the anesthetic management and weaning from CPB

A

yeah

48
Q

What is the most common cause of Mitral Regurg?

A

Myxomatous degeneration: breakdown of the valve

49
Q

What things determine the severity of mitral Regurg?

A
  • pressure gradient between LA + LV
  • size of regurgitant orifice
  • duration of ventricular systole
50
Q

What should you avoid with tricuspid Regurg?

A

Pulm htn and high PVR

51
Q

For tricuspid Regurg, how do you want the preload, high or low?

A

Normal to high preload

** treat hypotension with inotropes and volume (vasoconstrictors may worsen pulm htn)

Cardiology - Dr Constable (9 decks)

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