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Apex Flashcards > valvular heart disease > Flashcards

valvular heart disease Flashcards

1
Q

TAVR and type of anesthesia

A

aortic valve replacement for aortic stenosis (GA or MAC)

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2
Q

TAVR and SAPIAN valve

A

requires balloon valvuloplasty
need for rapid ventricular pacing (160-200BPM)
apnea during deployment
pacing pads in case pacing goes unwell
valve in valve (another valve) if deployment doesn’t go great

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3
Q

TAVR and core valve

A

if core valve is used, dont need valvuloplasty or rapid ventricular pacing
if it doesn’t deploy properly, retrieve and re deploy

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4
Q

best place to listen for aortic stenosis

A

A
2nd ICS at right sternal border

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5
Q

s1 and where to listen

A

C (tricuspid area) or D (mitral area)
left of sternal border at 4th ICS (apex) or
mid clavicular line on left at 5th ICS (apex)
closure of mitral and tricuspid valves, end of LV filling and beginning of isovolumic contraction

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6
Q

s2 and where to listen

A

A (aortic) or B (pulmonic area)
right or left sternal border at 2nd ICS
closure of pulmonic and aortic valves
beginning of diastole, onset of isovolumic relaxation

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7
Q

s3

A

suggests flaccid and inelastic heart- think HF

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8
Q

s4

A

caused by atrial systole, heart before s1, think poor compliance

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9
Q

what happens to EF with concentric hypertrophy

A

normal

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10
Q

what happens to EF with eccentric hypertrophy

A

reduced

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11
Q

replication of sarcomeres with concentric hypertrophy are in

A

parallel

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12
Q

replication of sarcomeres with eccentric hypertrophy are in

A

series

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13
Q

normal aortic valve orifice

A

2.5-3.5cm^2

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14
Q

severe aortic stenosis aortic valve orifice

A

<0.8cm^2

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15
Q

etiologies of aortic stenosis (3)

A

bicuspid aortic valve and calcification of valve leaflets
rheumatic fever
infective endocarditis

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16
Q

what does this pressure volume loop indicate?

A

aortic stenosis
PV loop height increases
EDV and ESV also increase (shift to the right)

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17
Q

classic presentation of aortic stenosis (pneumonic)

A

SAD
syncope, angina, dyspnea

18
Q

anesthetic management of AS patient
(preload, contractility, HR, SVR, PVR)

A

“full slow and constricted”
slower side of NSR
increase preload
maintain contractility
maintain or increase SVR
maintain PVR (dont increase)

19
Q

this arterial waveform is indicative of a patient with

A

aortic stenosis
lower systolic upstroke, delayed peak
pulsus parvus (waveform of small amplitude and narrow PP)
dichrotic notch may not be present, may look “dampened” overall
pulsus tardus

20
Q

what does this pressure volume wave form represent

A

chronic aortic regurgitation

21
Q

what does this pressure volume wave form represent

A

mitral stenosis

22
Q

what does this pressure volume wave form represent

A

chronic mitral regurgitation

23
Q

what does this pressure volume wave form represent

A

chronic mitral regurgitationc

24
Q

conditions associated with chronic AI (4)

A

valvular calcification, marfan, ehlers danlos, ankylosing spondylitis

25
Q

anesthetic management of a patient (type) with AI
(HR, preload, contractility, SVR, PVR)

A

“full fast forward”
HR increase
preload maintain or increase
contractility maintain
SVR decrease
PVR maintain

regional anesthesia: sympathectomy will reduce after load and regurgitant fraction (this is beneficial)

26
Q

what is this arterial line waveform indicative of

A

aortic insufficiency
sharp upstroke, low DBP, wide PP
biphasic systolic peaks (biferens pulse)

27
Q

normal mitral valve orifice

A

4-6cm^2

28
Q

which trans valvular gradient pressure and PASP are indicative of MS (and orifice size)

A

LA-LV gradient above 10mmHg with PASP >50mmHg
(severe MS orifice <1cm^2)

29
Q

most common cause of MS

A

rheumatic fever

30
Q

other etiologies of MS include (6)

A

RA, SLE, congenital defect, left atrial myxoma, carcinoid syndrome, iatrogenic following mitral valve repair

31
Q

pathophysiology of MS
(including compensation)

A

lower EDV, SV, CO–> body compensates by increasing SVR (since BP=COxSVR)

32
Q

anesthetic management of MS (HR, preload, contractility, SVR, PVR)

A

full slow and constricted
slower side of normal HR
maintain preload
maintain contractility
maintain SVR (tx HoTN with vasoconstrictor like neo or vaso)
avoid increase in PVR
if INR <1.5, neuraxial anesthesia ok (stasis in LA means increased risk of thrombosis)

33
Q

after suffering an MI, a patient presents with LV papillary muscle rupture and MR. what should the anesthetic management be? think HR, pressure gradient, SVR

A

increased to normal HR (avoid bradycardia)
decrease LV to LA pressure gradient
decrease SVR
“full fast and forward for MR”

34
Q

etiologies of mitral insufficiency (10)

A

rheumatic fever
ischemic heart disease
papillary muscle dysfunction
ruptured chordae tendinae
endocarditis
mitral valve prolapse
LVH
SLE
RA
carcinoid syndrome

35
Q

what does the pressure volume loop look like for acute versus chronic mitral insuffeciency?

A
36
Q

conditions that would worsen mitral insufficiency

A

slower HR
increased pressure gradient between LV and LA
increased SVR
increased size of valve orifice

37
Q

anesthetic management of mitral regurg (HR, preload, contractility, SVR, PVR)
anesthesia type that is beneficial

A

full, fast, fwd
HR: increased
preload: maintain or increase
contractility: maintain
SVR: decrease
PVR: avoid increase
Regional anesthesia: sympathectomy reduces SVR, promotes forward flow, and reduces regurg. however, reducing aortic DBP can compromise CPP

38
Q

which valvular disorders are associated with a systolic murmur?

A

mitral insufficiency (atrial systole/atrial kick problem)
aortic stenosis

39
Q

ASSS mnemonic

A

aortic stenosis is a systolic murmur heard at the right sternal border
may be able to be palpated as a thrill, LVP can exceed 350mmHg

40
Q

ARDS mnemonic

A

aortic regurgitation and diastolic murmur heard at the right sternal border
characterized as a high pitched blowing murmur

41
Q

MSDA mnemonic

A

mitral stenosis is a diastolic murmur heard at the apex and the left axilla
opening snap followed by an intensely rumbling murmur (pressure of LA can reach up to 35mmHg)

42
Q

MRSA mnemonic

A

mitral regurg is a systolic murmur heard at the apex and left axilla
holosystolic, characterized by a swishing sound

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