Valvular Heart Disease

Question 1

What physiologic symptoms can be devastating for a mitral stenosis patient?

Answer 1

Decreased SVR and Tachycardia
(Your body cannot compensate because increased tachycardia further decreases CO)

Question 2

What is the go-to pressor in mitral stenosis?

Answer 2

Phenylephrine

Question 3

What position might Mitral stenosis patients not tolerate?

Answer 3

Trendelenburg

Question 4

Should you use an Epidural or spinal on mitral stenosis patients?

Answer 4

Epidural (better BP control)

Question 5

What drug do you want to uses to reverse patients with Mitral stenosis?

Answer 5

Suggammadex (Glycopyrrulate increases HR)

Question 6

What induction med should you avoid in MS?

Answer 6

Ketamine (increases HR & pulm. HTN)

Question 7

Which patients have low threshold for cardioversion?

Answer 7

Mitral Stenosis

Question 8

What are typical findings of someone with MR?

Answer 8

Ischemic heart Disease
Endocarditis
Papillary Muscle Dysfunction

Question 9

What can cause papillary muscle dysfunction?

Answer 9

MI, Trauma

Question 10

What condition do you want to avoid phenylephrine?

Answer 10

Mitral Regurgitation

Question 11

Who might be a good candidate for neuraxial anesthesia?

Answer 11

Mitral Regurgitation (benefit from vasodilation)

Question 12

What induction medication is good for MR patients?

Answer 12

Ketamine (Higher HR)

Question 13

An older patient (>65) who has aortic stenosis is usually due to what cause?

Answer 13

Calcified aortic valve

Question 14

Someone who has AS and has angina has what life expectancy?

Answer 14

5 years

Question 15

Someone who has AS and has syncopal episodes has what life expectancy?

Answer 15

3 years

Question 16

Someone who has AS and has dyspnea on exertion has what life expectancy?

Answer 16

2 years

Question 17

What CXR change would someone with AS have?

Answer 17

Prominent ascending aorta due to post-stenotic aortic dilation

Question 18

What qualifies someone with AS for a TAVR?

Answer 18

1. Age over 65 years old
2. Tri-leaflet aortic valve
3. Good flow (absence of anatomical features)

Question 19

What are anesthetic goals for someone with AS

Answer 19

Prevent hypotension & increase CO (Maintain NSR)

Question 20

Is bradycardia or tachycardia worse in aortic stenosis?

Answer 20

Tachycardia (both are bad though)

Question 21

What induction drugs should you avoid in Aortic Stenosis patients?

Answer 21

Propofol (decreases SVR)
Ketamine (increases HR)

Question 22

What if you want to opioid induction someone with AS?

Answer 22

Fentanyl

Question 23

What induction drug is best for someone with aortic stenosis?

Answer 23

Etomidate

Question 24

What drug should you use to increase BP in someone with AS?

Answer 24

Phenylephrine

Question 25

What if your patient with AS develops Junctional rhythm or Bradycardia?

Answer 25

Be aggressive - Ephedrine, Atropine or Glycopyrrulate

Question 26

What if your patient with AS develops Tachycardia?

Answer 26

Beta Blockers (esmolol)

Question 27

What leads to worsening of Aortic Regurgitatin?

Answer 27

Systolic HTN

Question 28

What should you avoid (cardiac wise) with Aortic Regurgitation?

Answer 28

Bradycardia (Keep HR > 80)

Question 29

How do you minimize myocardial depression in AR?

Answer 29

Nitroglycerine to reduce afterload Milrinone for inotropy (LV help)