Valves Flashcards
What is mitral valve prolapse
Prolapse of one or both mitral valve leaflets into the left atrium during systole
What disorder can accompany MVP
Mitral regurgitation- it can be with or without it
What type of murmur is associated with mvp
Systolic murmur
Name the most common form of valvular heart disease
MVP
MVP can be associated with what conditions
Marfan Rheumatic carditis Myocarditis Thyrotoxicosis SLE
What symptoms do MVP patients have
Anxiety Orthostatic symptoms Palpitations Dyspnea Fatigue Atypical chest pain Cardiac dysrhthmias
Patients experiencing cardiac dysrhythmias respond well to which drugs
Beta blockers
In MVP what is done to decrease the degree of mvp
Keep left ventricle large-decrease ventricular emptying and increase ventricular volume via HTN-vasoconstriction- myocardial depression and volume resuscitation
True or false
Most patients with mvp have normal left ventricular function and tolerate all forms of general and regional anesthesia
True
Should ketamine be used in mvp
No- poor choice due to its ability to stimulate the sympathetic nervous system and enhance left ventricular emptying causing increase in prolapse and regurgitation
Name the two factors associated with the development of aortic stenosis
Calcified aortic stenosis- from aging
Bicuspid aortic valve - most common congenital valvular abnormality
If a patient has BAV what age does stenosis develop
Often develops earlier in life age 30-50
What other complication is associated with BAV- leading to what higher risk
Dilatation of the aortic root and or ascending aorta- giving them a higher risk of aortic dissection and rupture
Why do patients with aortic stenosis develop angina in the absence of coronary disease
The concentric hypertrophy creates increase in myocardial oxygen requirements and the stenosis valves create increase in myocardial work
What are the classical symptoms of critical aortic stenosis
SAD
syncope
Angina pectoris
Dyspnea on exertion
Why is it important to listen for systolic murmurs in older patients scheduled for surgery
Many patients with aortic stenosis are asymptomatic
Auscultation in a patient with AS reveals what type of murmur
Systolic murmur
Heard best in the aortic area
The systolic murmur in AS may mimic what.?
Mimic carotid bruit-echo to confirm but remember these patient frequently have concomitant carotid artery disease- so this finding could deserve special attention
In the elderly symptomatic patients with AS-what lab finding may be concerning and why
Elevated levels of bnp may suggest clinical decompensation- an elevated bnp has been associated with a decreased 1 year survival after AVR
Can coronary revascularization occur at the same time as avr
Yes
Tavr is contraindicated in patients with ____why
BAV owing to concerns of malfunction and malposition because of the abnormal valve anatomy
In patients with AS what symptoms can occur if hypotension develops
Myocardial ischemia and further deterioration in left ventricular function and cardiac output.
Hypotension treatment is mandatory to prevent cardio genie shock and or cardiac arrest
What anesthesia is avoided in AS
General is preferred over epidural or spinal as regional can lead to significant hypotension- avoid ketamine due to tachycardia
Opioid induction may be useful if left ventricular function is compromised
Patients with AS can be maintained with what combination of drugs during anesthesia
Nitrous oxide + volatile anesthetic + opioids or with opioids alone
In a patient with AS and marked left ventricular dysfunction- how should anesthesia be maintained
Nitrous oxide + opioids or opioids alone in high doses is recommended
Patients with AS should be treated with what drug when hypotensive
Phenylephrine
Patient with AS DEVELOPS A JUNCTIONAL RHYTHM OR BRADYCARDIA- what three meds must you consider
Atropine-ephedrine- glycopyrrolate
Patient with as develops SVT- how do you terminate it
Promptly with cardioversion
AS patients have a propensity to develop ventricular dysrhythmias- what must you have available
Lidocaine- amiodarone and defibrillator
In patients with AS- what is it important to remember about pulmonary occlusive pressure reading
It may overestimate left ventricular end diastolic volume because of the decreased compliance of the hypertrophied left ventricle
What is the result of ACUTE aortic regurgitation
The ventricle has not had time to compensate- leading to coronary ischemia rapid deterioration in left ventricular function and heart failure
When do symptoms appear for aortic and mitral regurgitation
When left ventricular dysfunction is present
