Valves

Question 1

What kind of HR do you want with stenotic valves?

Answer 1

Slower

Desirable to increase transvalvular flow with stenotic lesions. (good to have slow HR)

Question 2

What kind of HR do you want with regurgitant valves?

Answer 2

Faster, less time in diastole

Question 3

What is contraindicated with severe AS?

Answer 3

Spinal anesthetic contraindicated in aortic stenosis - sympathectomy below level, cant produce sympathetic response, will drop BP..give neo.

Want slower HR

Question 4

Do stenotic valves respond to changes in loading?

Answer 4

no - usually fixed

Question 5

Do regurgitant valves respond to changes in loading?

Answer 5

The valve area in regurgitant lesions can respond to changes in loading conditions (preload, afterload)

Question 6

1 cause of AS?

Answer 6

Calcific Aortic Stenosis

Question 7

Normal AVA =

Answer 7

2.6 – 3.5 cm2

Question 8

Mercedes benz?

Answer 8

healthy Tri-leaflet aortic valve

Question 9

classic symptoms of AS

Answer 9

(AS) are heart failure (HF), syncope, and angina. However, these “classic” manifestations reflect end-stage disease.

Now, the most common presenting symptoms:
●Dyspnea on exertion or decreased exercise tolerance
●Exertional dizziness (presyncope) or syncope
●Exertional angina

Question 10

Ischemia in AS causes

Answer 10

Relative decrease in myocardial capillary density- Hypertrophy not normal tissue.

Question 11

Is pressure higher in the aorta or the LV with aortic stenosis?

Answer 11

LV!

stenosis of the aortic valve causes obstruction to blood flow from the left ventricle (LV) to the aorta. As a result, there is a systolic pressure gradient across the valve with a higher pressure in the LV than the aorta

Question 12

What is th gradient for severe AS

Answer 12

<0.9

Question 13

1 cause of aortic regurg

Answer 13

Rheumatic heart disease damages the valve

Question 14

What happens to CPP with aortic regurg?

Answer 14

Reduced coronary perfusion pressure*
Lower diastolic pressure
Increased LVEDP

increased pulse pressure

Question 15

Regurg saying

Answer 15

fast, full, forward

Question 16

Goals for AS

Answer 16

increased preload, slow HR, maintain sinus rhythm

Question 17

goals for regurg

Answer 17

fast, full, forward, lower afterload to improve forward flow

Question 18

Normal MVA

Answer 18

4 – 6 cm2

Question 19

causes of MS

Answer 19

Rheumatic
Women 4x > Men

Question 20

Is lV function usually normal with MS?

Answer 20

Yes. LV function is usually normal

Question 21

Is RV function usually normal with MS?

Answer 21

RV function is normal in absence of pulmonary hypertension (PAH)

Severe pulmonary hypertension will result in RV failure and secondary abnormalities of LV function

Question 22

What to avoid with MS?

Answer 22

Frequently have elevated PA pressures. Avoid acidosis, hypercarbia, and/or hypoxemia.

Question 23

Causes of MR

Answer 23

Rheumatic disease
Endocarditis
Mitral valve prolapse-ballooning back of leaflet
Mitral annular enlargement-prevents closure
Ischemia
Myocardial infarction
Trauma
Fenfluramine diet suppressants

Question 24

Do measurements of the lV tend to be slightly elevated with MR?

Answer 24

Measurements of LV function tend to be slightly elevated
Moderately depressed ejection fraction in a patient with MR may be indicative of a severely depressed inotropic state

Question 25

Goals for MR care

Answer 25

faster HR, increased contractility, afterload reduction, preload based on patient response to fluid load

Question 26

Hypertrophic cardiomyopathy and SAM

Answer 26

May have Systolic Anterior Motion (SAM) of the mitral valve
The anterior leaflet of the mitral valve moves toward the septum during systole. Narrowing tract. This creates dynamic outflow tract obstruction and mitral regurgitation.

Question 27

What to avoid in hypertrophic cardiomyopathy

Answer 27

Avoid anything that causes reduction in left ventricular volume

Avoid:
Decreased preload
Increased contractility
Decreased afterload
Higher heart rates

Question 28

More on hypertrophic cardiomyopathy

Answer 28

Under some conditions (e.g., exercise training) remodeling is beneficial; however, under other conditions (e.g., heart failure) this remodeling is deleterious because it increases the oxygen demand of the heart and decreases mechanical efficiency. Certain drugs, such asbeta-blockers, angiotensin-converting enzyme inhibitorsandangiotensin receptor blockershave been shown to prevent or partially reverse remodeling under pathologic conditions.

Answer 29

Avoid hypovolemia

Decreased HR reduces oxygen demand of thickened myocardium. May also allow time for adequate LV filling.

Decreased contractility reduces gradient across LVOT. Beta-blockade is beneficial.

Want Increased afterload, it reduces the gradient across LVOT. Thickened myocardium requires increased diastolic BP.