Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology - Constable Summer > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Stenotic valves are ___________ related

A

pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Regurgitant valves are _________ related

A

volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aortic stenosis may occur at 3 levels. What are they?

A

valvular, subvalvular, supravalvular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Valvular Aortic Stenosis variations (3)

A
  1. Calcification + fibrosis of normal aortic valve (very common) 2. Calcification + fibrosis of congenital bicuspid AV 3. Rheumatic - uncommon since antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Say you have a 40 year old that starts to have problems with SOB, faftigue, syncope, dyspnea and angina, it is probably a due to a symptomatic what?

A

congenital bicuspid valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal AVA

A

2-4 cm2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Severe AS

A

< 1 cm2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If someone has low EF, don’t use _____ _______ as an indicator for AS

A

pressure gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If normal LV function, the mean PG should be

A

> 50 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathophysiology of Aortic Stenosis

A

Chronic LV pressure overload that leads to EARLY concentric LVH to DECREASE wall stress. LVH leads to DECREASED diastolic compliance, decreased coronary blood flow and imbalance of MV02 supply-demand. Decreased diastolic compliance leads to INCREASED LVEPD and LVEDV. Myocardial ischemia b/c of LVH leads to INCREASED wall stress (late AS), DECREASED diastolic coronary perfusion and DECREASED coronary flow reserve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Review slide 9

A

AS path

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hemodynamic goals for AS: ____ is crucial. Cardiovert _____ promptly. Optimal HR is __to ____. Tachycardia will lead to ischemia and ectopy. Bradycardia will lead to low CO due to a FIXED SV.

A

SR / SVTs / 60 to 80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hemodynamic goals for AS: Adequate ______ is essential but difficult to predict b/c diastolic dysfunction. _____ can be useful. Maintain contractility and avoid myocardial _________.

A

preload / TEE / depresssants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How and when would you treat hypotension with someone with AS

A

PROMPTLY with phenylephrine, volume, trendelenburg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Any stenotic problems you want to maintain ______

A

SR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The two most difficult problems to resuscitate on the floor are

A

AS and hypertrophic cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Drugs to maintain CPP in a patient with AS

A

phenylephrine, norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T/F Atrial kick is crucial in someone with AS as well as maintaining a HR 60-80

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Spinal and epidural anesthesia are ______ tolerated in the patient with AS if the preload is decreased and HR increased

A

poorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens when someone receives a spinal that can affect AS?

A

Drops the BP from vasodilation and increases HR in response to low BP. All this is bad for someone with AS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Premedication for AS

A

young and anxious get benzos but if frail and elderly decrease the dose or avoid benzos all together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Intraopertive considerations

A

Arterial line pre-induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the best tool for AS intraopertively

A

TEE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Considerations for weaning someone with AS from bypass

A

Thick, hypertrophied heart may be difficult to protect (stone heart still occurs but it is rare). Noncompliant LV dependent on stable rhythm. Consider inotropes if preop LV dysfunction. Dynamic subaortic or cavitary obstruction after AVR if septal LVH. Treat with volume, Beta-blockers. Rarely need myomectomy [inotropes can worsen obstruction]

25
Q

In AS, Beta-blockers work by lowering the HR to increase _______ filling times

A

diastolic

26
Q

Aortic regurgitation etiology

A
  1. Aortic root dilation from HTN, aorta dissection, cystic medial necrosis, Marfans, syphilitic aortitis, ankylosing spondylitis, osteogenesis imperfecta 2. deformed + thickened cusps from rheumatic, IE, bicuspid valve 3. cusp prolapse and dissection
27
Q

In AR, basically the leaflets are ________ apart. Any ______ ______ disorder can cause aortic root dilation. You can also have AS with a perforated cusp which causes _________

A

thethered / connective tissue / regurgitation

28
Q

With CHRONIC AR, the patient may be ________ for years. LV volume and pressure ________ occurs. LV maintains systolic fxn by ________ and increased compliance. LV decompensates at later stages with INCREASED LVEDP + LVEDV which leads to ______, arrhythmias and sudden death.

A

asymptomatic / overload / dilation / CHF

29
Q

With ACUTE AR, the LV is unable to ________ ACUTELY so LV volume ________ occurs. This INCREASED LVEDP + LVEDV manifests as acute _____ _________ and emergency surgery is often required.

A

dilate / overload / pulmonary edema

30
Q

Hemodynamic goals for AR

A

Optimal HR is 90. Avoid bradycardia because that will increase regurgitation. Avoid high afterload so SNP (nipride) is preferred. Acute AR often need inotropes + vasodilator [epi + SNP/milrinone]. IABP is contraindicated.

31
Q

Why is IABP contraindicated in someone with AR?

A

It would worsen the regurgitation

32
Q

IN AR we want to think FAST, FORWARD and FULL. What does this mean?

A

Fast HR, forward flow, and full heart.

33
Q

Anesthetic management for AR

A

premed with benzos, routine monitoring (a-line, CVP, PAC), TEE beneficial, narcotic based technique if impaired LV. If acute AR you will want to do an RSI with ketamine and succinylcholine. Inotropes may be needed if acute AR or preop LV dysfunction

34
Q

Mitral stenosis is usually __________ - thickening, calcification + fusion of MV leaflets + commissures

A

rheumatic

35
Q

Mitral stenosis may be combined with ___ and ___

A

MR and AR

36
Q

What is the indication for Mitral Stenosis surgery?

A

If MVA < 1 cm2 with NYHA class III or IV dyspnea [or embolus like a LAA clot]

37
Q

With mitral stenosis the pressure gradient betweeen the ___ and ____ prevents LV filling

A

LA and LV

38
Q

Mitral stenosis pathophysiology

A

Pressure gradient between LA and LV prevents LV filling. Manifests as pulmonary HTN with increased LAP. An increased LAP leads to LAE and atrial arrhythmias like afib. Pulmonary HTN also leads to RV dysfunction, RVE, and tricuspid regurg which may required TV repair. LV dysfunction uncommon unless the patient has CAD as well.

39
Q

Review slide 26

A

mitral stenosis

40
Q

**Hemodynamic goals with mitral stenosis

A

**Preserve SR if present. Avoid tachycardia which decreases diastolic filling of LV and worsens MS. AVOID FACTORS THAT WORSEN PULMONARY HTN (hypercarbia, acidosis, hypothermia, SNS activation, hypoxia)

41
Q

Anesthetic management for MS

A

Premedicate with benzos to avoid tachycardia. If pulmonary HTN present supplemental 02 should be used. Control of HR with beta blockers, digoxin, CCB and amiodarone

42
Q

Intraoperative management for MS

A

Esmolol is the single most useful drug with severe MS, even if CHF and pulm edema present. 10-20 mg bolus, 50-100mcg/kg/min infusion. N20 should be avoided b/c effects on pulm htn. Pancuronium should be avoided because it causes tachycardia

43
Q

Weaning from Bypass: MS

A

With MV replacement hemodynamics usually improved b/c obstruction to LV filling has been resolved. If preop pulm HTN and RV dysfxn present may need milrinone or nitric oxide

44
Q

Mitral Regurgitation is usually over time from _______ or long term from _______

A

degeneratioin / ischemia

45
Q

Other causes for MR

A

infective endocarditis and trauma

46
Q

MR pathophysiology

A

Volume overload of LV leads to LVE and LAE. The LA can massively dilate which leads to atrial arrhythmias and LAE. Dilated LV decompensates at later stages with INCREASED LVEDV

47
Q

Severity of MR is based on the pressure gradient between the ___ and ___, the size of the _____ ________ and the duration of _______ systole.

A

LA and LV / regurgitant orifice / ventricular

48
Q

Hemodyanmic goals for MR

A

Vasodilators like NTG, SNP. Decrease afterload + regurgitant fraction and increase forward flow. High normal HR to increase time of ventricular systole. Maintain contractility.

49
Q

Advantages of MV repair vs. replacement

A

preserved papillary muscle and chordae, enhanced LV function, requires TEE to assess repair

50
Q

Anesthetic management of MV repair

A

LV dysfunction can be unmasked after MV surgery b/c LV cannot offload into LA. So, may need inotropes and vasodilators.

51
Q

Tricuspid Regurgitation primary causes

A

rheumatic, infective endocarditis, carcinoid, Ebstein’s, trauma

52
Q

Tricuspid Regurgitation secondary causes

A

Chronic RV dilation, often with MV disease

53
Q

Tricuspid Regurgitation though is most often from what?

A

IV drug use because it’s the valve closest to the point of injection

54
Q

TR pathophysiology: RV + RA overloaded and dilated. RA very compliant so RAP rises only with ___ ___ disease. Pulmonary HTN due to concominant ____ disesase which increases RV afterload and worsens TR. RVE leads to paradoxical motion of LV septum with impaired LV filling and compliance. You will see right heart failure with it backing up to the liver causing _______ and ________.

A

end stage / MV / hepatomegaoly / ascites

55
Q

If TR is secondary to MV disease, you want to treat the ____ heart lesion.

A

left

56
Q

TR hemodaynamic goals

A

avoid pulm htn, avoid high PVR. Want a normal to high preload for RV stroke volume. Hypotension should be treated with inotropes + volume b/c vasoconstrictors may worsen pulm HTN

57
Q

TR anesthetic management

A

Premedicate with benzos , PAC if pulm htn + MV pathology but CO can be overestimated with severe TR. It also may be impossible to float a swan.

58
Q

TR weaning from CPB

A

If preop RV dysfunction/dilation consider inotropes, inodilators, vasodilators, and nitric oxide.

Cardiology - Constable Summer (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions