Valve Lesions

Question 1

Aortic Stenosis

Answer 1

Increased preload
Increased SVR
Decreased HR
Neutral contractility

Question 2

HOCM

Answer 2

Increased preload
Increased SVR
Decreased HR
Decreased contractility

Question 3

Mitral Stenosis

Answer 3

Increased preload
Neutral or increased SVR
Decreased HR
Neutral contractility

Question 4

Mitral Regurgitation

Answer 4

Increased preload
Decreased SVR (maintain SVR with MVP)
Increased HR (80-100bpm)
Neutral contractility

Question 5

Aortic Regurgitation

Answer 5

Decreased preload
Decreased SVR
Increased HR
Neutral contractility

Question 6

PCWP tracing

Answer 6

a wave - atrial systole
c wave - elevation of the MV during early LV systole
x descent - downward displacement of the LA during LV contraction
v wave - venous return against a closed MV
y descent - decline in atrial pressure as the MV opens during diastole

Question 7

Abnormalities in RA tracing

Answer 7

Elevated a wave - TV stenosis, dec RV compliance due to RV failure
Cannon a wave - A-V asynchrony (3rd deg AVB, VT, V-pacer)
Absent a wave - AF or Afib
Elevated v wave - TR, RV failure, red atrial compliance (restrictive myopathy)
Equal a & v waves - tamponade, constrictive myopathy

Question 8

Tricuspid regurgitation

Answer 8

Causes: rheumatic disease, pulm HTN, infective endocarditis, carcinoid syndrome, TV prolapse, Ebstein’s anomaly

Increase/maintain preload
Maintain SVR
Avoid tachycardia, hypoxia, hypercarbia, acidosis, N2O, inc airway pressures