Valvular disease

Question 1

S3 should make you think about ___ and is heard ____

Answer 1

Heart failure- flaccid and inelastic heart
Heard right after S2- gallop

Question 2

S4 is heard ____ and is caused by _____

Answer 2

Before S1
Atrial systole- decreased ventricular compliance

Question 3

ICS for heart valves

Answer 3

Aortic- 2nd R sternal border
pulmonic- 2nd L sternal border
tricuspid- 4th L sternal border
mitral- 5th midclavicular

Question 4

The diaphragm is best for listening to ___

Answer 4

s1, s2
murmur of aortic stenosis and mitral regurgitation

Question 5

The bell is best for listening to ___

Answer 5

s3, s4
murmur of mitral stenosis

Question 6

Valvular stenosis creates sarcomeres in a ___, this is known as ___ hypertrophy

Answer 6

parallel
concentric

Question 7

Valvular regurg creates sarcomeres in a ____, this is called ____ hypertrophy

Answer 7

series
eccentric

Question 8

Heart failure with increased pressure will do what to the EF?

Answer 8

Concentric hypertrophy
HFfEF

Question 9

Heart failure with increased volume will do what to the EF?

Answer 9

Eccentric hypertophy
HFrEF

Question 10

Normal aortic valve size, severe stenosis size

Answer 10

2.5-3.5 cm2
<1cm

Question 11

Classic presentation of aortic stenosis

Answer 11

Its SAD to have AS
Syncope
Angina
Dyspnea

Question 12

Anesthetic management for stenosed valves

Answer 12

Full
Slow
Constricted

Question 13

What is pulsus parvus? When is it seen?

Answer 13

Narrow pulse pressure- think dehydration like in parvo
Aortic stenosis

Question 14

Cause of aortic stenosis

Answer 14

Bicuspid valve and calcification

Question 15

Why is spinal anesthesia avoided in aortic stenosis?

Answer 15

Sympathectomy
Profound HOTN
Reduced coronary perfusion pressure
CV collapse

Question 16

How does mitral stenosis look on the graph?

Answer 16

Similar to AS, but shorter
Does not have the same affect because only pumping to the ventricle

Question 17

How does aortic regurg look on the graph?

Answer 17

Wide at the top
Thin at the bottom
CO might seem to be big (top), but its really small (bottom) because blood is coming back into the ventricle

Question 18

Anesthetic management for regurgitation

Answer 18

Full
Fast
Forward

Question 19

Which valvular disease is associated with conditions such as Marfan syndrome, ehler-danlos, and ankylosing spondylitis?

Answer 19

Aortic regurgitation

Question 20

When is bisferiens seen?

Answer 20

Aortic regurg

Question 21

Mitral regurg graph

Answer 21

Wide on top
Wide on bottom

Question 22

Cause of aortic regurg

Answer 22

Endocarditis
Trauma/ aneurysm

Question 23

N2O _____ PVR

Answer 23

Increases

Question 24

Normal mitral valve size, stenosed size

Answer 24

4-6cm2- bigger but why?
<1cm2

Question 25

Cause of mitral stenosis

Answer 25

Rheumatic fever
Endocarditis/ calcification

Question 26

Causes of mitral regurg

Answer 26

rheumatic fever

Question 27

Murmur mnemonic

Answer 27

ASSS
ARDS
MRSA
MSDA

Question 28

SAPIAN vs corevalve

Answer 28

Sapian- RVR / cardiac standstill
Corevalve- self expanding,

Question 29

3 surgical approaches to a TAVR

Answer 29

Transaortic
Transfemoral
Transapical

Question 30

If a SAPIAN does not deploy properly, the treatment is _____

Answer 30

“Valve in valve”
Another sapian valve is placed

Question 31

If corevalve is improperly deployed, treatment is ____

Answer 31

Retrieve and redeployed

Question 32

Left atrial pressure above _____ are indicative of pulmonary HTN

Answer 32

25mmhg

Question 33

What conditions will worsen pulmonary HTN?

Answer 33

Hypercarbia
hypoxia
hypothermia
acidosis
N2O
Desflurane
Trendelenburg

Question 34

Mitral regurg is considered severe when volume is over ____

Answer 34

60ml

Question 35

Risk factors for Aortic stenosis

Answer 35

Old age
Male
Smoker
HTN
HLD