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CV Anesthesia > Test 2 > Flashcards

Test 2 Flashcards

1
Q

_________ is useful during OPCAB despite cardiac displacement

A

TEE

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2
Q

Heart valve surgery continues to involve

A

Complex hemodynamic management

TEE assessment

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3
Q

___________ requires use of 3D TEE

A

Mitral Valve Repair

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4
Q

Valuable resource in management of cardiopulmonary instability in noncardiac patients

A

TEE

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5
Q

Benefits of TEE during CAB

A
  • Monitor ischemia
  • Hemodynamic performance
  • presence of ventricular air
  • cannula placement
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6
Q

Management of patients with aortic stenosis

A
  • Slow HR
  • Higher perfusion pressure
  • Monitor hemodynamic performance
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7
Q

Management of anesthesia in paitents with aortic insufficiency (regurgitation)

A
  • faster HR
  • optimal filling volume
  • minimize regurgitant flow
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8
Q

Management of patients with mitral insufficiency

A
  • faster HR
  • optimal filling volume
  • minimize regurgitant flow
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9
Q

Management of patients with mitral stenosis

A
  • slower HR
  • optimal filling volumes
  • maintain RV function
  • manage pulmonary HTN
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10
Q

TEE utilization in pt with aortic valve disease

A
  • measure aortic valve area/gradient
  • aorta and annular dimensions
  • assess for coexisting disease
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11
Q

Utilization of TEE in patients with mitral valve disease

A
  • measure mitral valve area/gradients
  • mitral valve anatomy
  • quality of repair
  • pulmonary HTN
  • biventricular function
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12
Q

Management of patient with aortic stenosis presenting for TAVR

A
  • heart rate manipulation
  • hemodynamic maintenance
  • assess valve position
  • assess paravalvular leaks
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13
Q

Qualitative TEE findings include

A

Volume status
Pericardial effusion
Contractility/bi-V function
Simple congenital cardiac defects

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14
Q

Quantitative TEE findings

A

PAP
CO
Valve function and area
Aorta dimension

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15
Q

Mitral stenosis is characterized by

A

Decreased SV

Decreased BP

Restricted diastolic inflow

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16
Q

Mitral stenosis pressure volume loops characteristically have

A

Decreased filling

Lower ventricular volumes

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17
Q

Mitral stenosis patients typically have

A

Pulmonary HTN and tricuspid regurg

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18
Q

Mitral stenosis patients typically have symptoms at rest when valve area

A

< 1.5cm

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19
Q

Pathological features of mitral stenosis include

A

LA enlargement

Decreased LV filling

Heart rate dependent CO

Sinus rhythm dependent BP

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20
Q

Moderate-severe mitral stenosis is associated with

A
  • orifice area <1.5cm
  • pressure half time >150ms
  • pressure gradient across the valve >5mmHg
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21
Q

Mitral regurgitation pressure volume loops characteristically have

A

Higher ventricular volumes and lack isovolumetric contraction component

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22
Q

Hemodynamic goals for mitral stenosis include

A

Slow-normal HR

Increased SVR

Maintenance of normal PVR

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23
Q

Moderate-severe mitral stenosis is often associated with

A

RV failure

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24
Q

Pathological features of mitral regurgitation include

A

LA enlargement

Eccentric LV hypertrophy
- accommodate increased LV volume and decreased forward SV

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25
Q

Moderate/severe mitral regurgitation is associated with a regurgitant jet/vena contracta __________ and regurgitant jet that occupies at least

A

> 3-6mm

2/3 LA by TEE

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26
Q

Hemodynamic goal in pt with mitral regurgitation

A

Normal-fast HR

Low-normal SVR

Preservation of intravascular volume/contractility

27
Q

Post-bypass management of mitral valve surgery patients typically employs

A

Inotrope

Lower BP

Faster HR

28
Q

Mitraclip is now being used for

A

Inoperable patients

Employs Alfieri stitch and TEE

29
Q

Mitra regurgitation limits

A

Net forward flow

30
Q

Principle compensatory mechanisms for mitral regurgitation

A

Fluid retention

Eccentric hypertrophy

31
Q

Mitral stenosis results in

A

LA hypertrophy

Fixed SV

32
Q

Mitral valve stenosis results in PCWP

A

Always overestimating LVEDP

33
Q

During induction/maintenance of mitral stenosis

A

Avoid hypercapnia/hypoxia. (Increases PVR and causes RV failure)

34
Q

Acute treatment of pulmonary HTN and RV failure

A

Hyperventilation

High FiO2 (prevent HPV)

Nitric Oxide

NTG

Isuprel, dobutamine, epi, Miri one, NE

RVAD

IPABP

IABP

35
Q

RV dysfunction is extremely sensitive to

A

Afterload of PA

Optimal ventilation is key

36
Q

Induction and maintenance with mitral regurgitation

A

Faster, fuller, vasodilates

37
Q

Pressor for mitral regurgitation

A

NE

Avoid neo

38
Q

Benefits of TEE during CAB

A

Monitor ischemia

Monitor hemodynamic performance

ID presence of ventricular air

Cannula placement

39
Q

Management of patients with aortic stenosis

A

Slower HR

Higher perfusion pressures

Monitor hemodynamic performance

40
Q

Management of anesthesia in patients with aortic insufficiency

A

Faster HR

Optimize filling volume

Minimize regurgitant flow

Faster Fuller Forward

41
Q

Management of patients with mitral insufficiency

A

Faster HR

Optimal filling volume

Minimize regurgitant flow

faster fuller forward

42
Q

Management of patients with mitral stenosis involves

A

Slower HR

Optimal filling volumes

Maintenance of RV function

Management pulmonary HTN

43
Q

TEE is used in pt with aortic valve disease to

A

Measure AV area/gradient

Aorta and annular dimensions

Assess for coexisting disease

44
Q

TEE is utilized in patients with mitral valve disease to

A

Measure MV valve area/gradient

MV anatomy

Quality of repair

Pulmonary HTN

Biventricular function

45
Q

Management of patients with aortic stenosis presenting for TAVR

A

HR manipulation

Maintenance of hemodynamics

Assess valve position

Assess for paravalvular leaks

46
Q

Qualitative TEE findings

A

Volume status

Pericardial effusion

Contractility/Bi ventricular function

Simple congenital cardiac defects

47
Q

Quantitative TEE findings

A

PAP

CO

Valve function/area

Aorta dimensions

48
Q

How body compensates fro heart valve disease

A

SNS activation

Increasing intravascular volume

Modified chamber dimensions

49
Q

Aortic stenosis pressure volume loops characteristically have

A

Higher intraventricular pressure-volume relationships

50
Q

Aortic regurgitation pressure volume loops characteristically have

A

Higher ventricular volumes

Lack isovolumic relaxation component

51
Q

Pathological features of aortic stenosis

A

Concentric ventricular hypertrophy

Pressure overloading/high LV tension

Increased MVO2

52
Q

Severe/critical AS is associated with

AV area

Aorta/LV gradient

Peak aortic jet velocity

A

AV valve area <1cm

Aorta/LV gradient >40mmHg

Peak aortic jet velocity >4m/s

53
Q

Symptomatic aortic stenosis and/or NYHA III-IV should receive what for major surgery

A

Arterial line

PAC/TEE

54
Q

Hemodynamic goals in paitents with aortic stenosis include

A

Slow-normal heart rate

Normal SVR

Preservation of LV contractility

55
Q

Anesthetic considerations prior to CPB include

A

Assess aorta for plaque

Heparinization (300-400units/kg)

ACT >400seconds

56
Q

Best TEE window for assessing ventricular function and filling is

A

Transgastric view

57
Q

Hemodynamic goals post CPB in patients with AS include

A

Maintain optimal LV filling

SR

Judicious use of inotrope

58
Q

Mediastinal bleeding >_____ necessitates re-exploration in OR

A

300ml/hr

59
Q

Cerebral protection during circulatory arrest may include

A

Profound hypothermia

Ice to head

Propofol infusion

Monitor cerebral oxygen saturation

60
Q

Anesthesia considerations for patients with hypertrophic cardiomyopathy (HOCM) include

A

Maintain adequate intravascular volume

Increased SVR

Myocardial depression

Deep anesthesia

61
Q

Pathological features of aortic regurgitation include

A

Eccentric LV hypertrophy

Volume overload

Decreased net SV

62
Q

Severe/moderate aortic regurgitation is associated with

Vena contracta

Pressure half time

Regurgitant jet

A

Vena contracta >6mm

Pressure half time <200

Regurgitant jet >65% width of LV outflow tract

63
Q

Anesthesia management of patients with aortic regurgitation includes

A

Maintenance of faster HR

Lower SVR

Preservation of contractility

CV Anesthesia (4 decks)

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