Valve Disease Flashcards
h&p valve disease assess 4 things
Severity of disease, degree of contractility impairment, assoc major organ disease, development of compensatory mechanisms to maintain CO (inc sns, cardiac hypertrophy)
Exercise tolerance evaluates what
Cardiac reserve
CHF manifests as 3 signs, companion of what
Dyspnea, orthopnea, fatigue. Chronic valvular heart disease
Compensatory inc SNS manifested by which signs
Anxiety, diaphoresis, resting tachycardia.
Common specific cardiac signs of valvular heart disease
Dysrhythmias (afib), angina (inc muscle mass w/not enough 02 delivery)
Drug tx: 3 most common
Dig, diuretics, abx prophylaxis
Digitalis indication
Inc contractility, decrease hr response w afib
Diuretic: indication but may result in
Tx extra fluid vol but could result in hypokalemia and dig toxicity
Lab data: 3
Doppler echo, cardiac cath to measure VHD severity, arterial bg dec pao2 and v-q mismatch
Mitral stenosis: patho, size, pressure gradient to maintain CO
Fusion of MV leaflets at commissaries during healing of rheumatic fever. <1 cm, 25 mmhg
Mitral stenosis: predisposition to what and why
LA enlargement- afib. Blood stasis in distended LA- thrombi, need anticoag
Mitral stenosis symptoms
DOE when CO inc, severe leads to HF
Mitral stenosis anesthesia goals: 3 main
Slow (avoid ST/RVR In afib), tight (avoid over transfusion/head down), full (avoid drug induced dec SVR)
MS: avoid what things that might exacerbate condition in anesthesia
Hypoxemia +/- hypoventilation, could exacerbate pulm htn and evoke right vent failure
Mitral stenosis induction: avoid what 2 things
IV drugs that are unlikely to inc HR (ketamine) or abruptly decrease SVR. Give etomidate or hi dose opioid
Mitral stenosis: maintenance aims
Minimize sustained changes in HR/SVR/PVR and contractility. Good: BB and CCB.
Mitral regurg patho
Rheumatic fever, almost always assoc w mitral stenosis
Mitral regurg: __ overload by retrograde flow on portion of ___ into LA
LA volume, LV stroke volume
Mitral regurg: how it shows on PA recording, size correlates to what
V wave= regurgitant flow. Size= magnitude of regurg flow
Mitral regurg: anesthesia management 3 main goals
Fast (avoid sudden hr decrease), full (avoid sudden SVR decrease), forward (dont want myo dep- IA)
Mitral regurg: induction
Avoid excessive changes in SVR or HR decrease
Mitral regurg: maintenance: influenced by what
LV dysfunc. If not severe: NO + iso
Mitral regurg: LV dysfunc severe, do which technique
Opioid, minimizes myo depression.
AS: patho
Degen/calcification d/t aging. Bicuspid valve. RA or endocarditis
AS: gradient and size. Triad
<1 cm, >50 mmHg. Angina in absence of ischemia, DOE, syncope
AS anesthesia management goals
Avoid further CO decrease. Maintain NSR, avoid tachy/bradycardia, avoid sudden SVR decrease, optimize volume to maintain venous return/LV fillling
AS: which kind of anesthesia preferred
General over epidural/spinal to avoid SVR decrease
Aortic regurg patho
Acute (infective, endocarditis, trauma, thoracic aneurysm dissection), or chronic (RF prior, systemic htn)
Aortic regurg: anesthesia management goals
Avoid sudden HR decrease, SVR increase, minimize drug induced myo depression
Aortic regurg: induction w which drugs
Maintain forward left ventricular stroke volume
Aortic regurg: anesthesia maintenance
W NO + volatile (iso). If myo compromised use opioid alone maybe
Aortic regurg: what is imp for maintaining L SV
IV fluid volume and prompt blood replacement
Aortic regurg: tx what promptly w what
Bradycardia, glyco unless severe or glyco fails then go to atropine
Tricuspid regurg patho
Usually functional. Dilation of RV d/t pulm htn. RV vol overload. Well tolerated
Tricuspid regurg anesthesia management
Maintain IV fluid vol, avoid venous return drop, avoid hypoxia and hypercarbia
