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Physical & Health Assessment COPY - Grayson > Valvular Heart Disease (Exam II) > Flashcards

Valvular Heart Disease (Exam II) Flashcards

1
Q

What is the incidence of valvular disease in the US population?

A

2.5%

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2
Q

What is the NYHA Functional Classification of Patients with Heart Disease?

A

I - Asymptomatic.
II - s/s with activity but relieved by rest.
III - s/s w/ minimal activity, relieved by rest.
IV - s/s at rest

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3
Q

What causes a murmur?

A

turbulent flow across a heart valve
or
↑ flow across normal valves

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4
Q

Systolic murmurs are caused by what valve pathologies?

A
  • Aortic/Pulmonic Stenosis
  • Mitral/Tricuspic Regurgitation

midsytolic or holosystolic

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5
Q

Diastolic murmurs are caused by what pathologies?

A
  • Aortic/Pulmonic Regurgitation
  • Mitral/Tricuspid Stenosis
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6
Q

_____ murmurs follow S2.

A

Diastolic

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7
Q

Midsystolic murmurs occur when?

A

Between S1 and S2 sounds

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8
Q

Which murmur type exhibits a crescendo-decrescendo pattern?

A

Mid-systolic Murmurs

can be functional/least limiting

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9
Q

What characterizes holosystolic murmurs?

A

S1 and S2 merging

most scary

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10
Q

Where is the aortic valve auscultated?

A

2ⁿᵈ ICS, right sternal border

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11
Q

Where is the pulmonic valve auscultated?

A

2ⁿᵈ ICS, left sternal border

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12
Q

Where is the tricuspid valve auscultated?

A

5th ICS, left sternal border

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13
Q

Where is the mitral valve auscultated?

A

5th ICS, mid-clavicular line

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14
Q

What factors seen on a chest x-ray would indicate valvular disease?

A
  • Cardiomegaly
  • Left Bronchus Elevation
  • Valvular Calcifications
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15
Q

What signs seen on an EKG could indicate valvular disease?

A
  • LA enlargement (broad, notched p-wave)
  • Axis deviations
  • Dysrhythmias
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16
Q

What type of valve replacement is thrombogenic?

A

Mechanical

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17
Q

What are bioprosthetic valves made from?

A

Porcine or bovine

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18
Q

Which type of prosthetic valve is longer lasting?

A

Mechanical

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19
Q

Who is most commonly affected by mitral stenosis?

A
  • Women
  • Rheumatic patients
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20
Q

What is the normal mitral valve orifice surface area?

A

4 - 6 cm²

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21
Q

At what surface area do symptoms for mitral valve stenosis start to develop?

A

< 2 cm²

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22
Q

What are the s/s of mitral stenosis?

A
  • Exertional dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Pulmonary edema
  • Pulmonary HTN
  • A-Fib

*opening snap early in diastole

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23
Q

How is mitral stenosis treated?

A
  • Rate control (80bpm goal): BB, CCB, DIG
  • ↓LAP (diuretics)
  • Anticoagulation
  • Surgical correction
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24
Q

What EKG abnormalities are common with mitral stenosis?

A
  • Notched P waves
  • A-Fib
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25
Q

What are the anesthetics goals for a patient with mitral stenosis?

A

Maintain normal parameters for HR, volume status, and afterload.

26
Q

What is more common, mitral stenosis or regurgitation?

A

Regurgitation (2% of US population)

27
Q

What type of murmur would be auscultated with mitral regurgitation?

A

Holosystolic murmur at the cardiac apex

28
Q

What less invasive cath lab procedure is used to treat mitral regurgitation?

A

Mitra-clip

repair&raquo_space;> replacement

29
Q

What β-blocker is preferred for mitral regurgitation?

A

Carvedilol

…can also give ACE-I

30
Q

What are the anesthetic goals for mitral regurgitation patients?

A
  • Improve LV stroke volume
  • Decrease Regurg
  • Avoid bradycardia
  • Avoid ↑ SVR

FAST, FULL, FORWARD

31
Q

What heart rate would you want to maintain with mitral regurgitation?

A

Normal to slightly increase HR

Bradycardia will increase LV volume overload.

32
Q

What type of pathology would cause early-life development of aortic stenosis?

A

Bicuspid Aortic Valve

…most common congenital valvular abnormality

33
Q

What is the normal surface area of the aortic valve?

A

2.5 - 3.5 cm²

34
Q

What is the surface area of a severely stenotic aortic valve?

A

< 1 cm²

35
Q

What pathology would be expected for a systolic or mid-systolic murmur hear in the right upper sternal border?

A

Aortic Stenosis

36
Q

What symptoms are seen with aortic stenosis becomes critical?

A
  • Angina
  • Syncope*
  • Dyspnea on exertion
37
Q

____% of aortic stenosis patients will die within three years without a valve replacement

A

75%

38
Q

What EKG characteristics would be seen for a patient with aortic stenosis?

A
  • ST depression
  • T-wave inversion
  • LV hypertrophy
39
Q

What non-surgical treatments are available for aortic stenosis?

A
  • Balloon valvotomy for younger patients
  • TAVR
40
Q

What type of anesthetic technique is generally better for patients with aortic stenosis?

A

General Anesthesia

Opioid induction agent

41
Q

What are common causes of chronic aortic regurgitation?

A
  • Endocarditis/rheumatic fever
  • Bicuspid AV
  • Anorexigenic drugs
42
Q

What are the two common causes of acute aortic regurgitation?

A
  • Endocarditis
  • Aortic dissection
43
Q

What two factors determine the degree of regurgitant blood flow from a dysfunctional aortic valve?

A
  • Time available for flow (HR)
  • Pressure gradient (SVR)
44
Q

What type of murmur would be heard with aortic regurgitation?

A

Early to mid-diastolic murmur at left sternal border (Austin-Flint murmur)

45
Q

What blood pressure abnormalities are often seen with aortic regurgitation?

A
  • Widened pulse pressure
  • Decreased DBP
  • Bounding pulses
46
Q

Anesthetic considerations for aortic regurge

A
  • Avoid bradycardia, HR > 80
  • Avoid ↑ SVR
  • Minimize myocardia depression (vasodilator to reduce afterload, inotrope to increase contractility)

GA is usual choice

47
Q

What disease frequently “co-exists” with valvular heart diease, increasing mortality..

A

Ischemic Heart Disease

48
Q

What are 3 pre-op signs of compensatory mechanisms for maintaining CO?

A
  • Increased SNS
  • Myocardial hypertrophy
  • Current therapy (meds)
49
Q

Afib is closly related to which valve issues?

A

Mitral stenosis/regurge

50
Q

Define functional murmur

A

A heart murmur that is primarily due to physiologic conditions outside the heart, as opposed to structural defects in the heart itself.

51
Q

Which murmur increases with squatting, decreases with valsalva and standing?

A

Aortic stenosis

can also pull legs up to test

52
Q

Aortic stenosis anesthetic considerations

A
  • Prevent hypotension
  • Avoid brady or tachy cardia w/atropine, ephedrine, glycopyrrolate or esmolol
  • Optomize fluid volume
  • Aggressive treatment of hypotension w/phenylephrine

CRP is typically not effective so don’t fuck up

53
Q

Which 2 murmurs increase with handgrip or blood pressure cuff inflation?

A

Aortic/mitral regurgitation

54
Q

All mitral murmurs can be heard best at the _______

A

Apex

55
Q

Which murmur increases with tachycardia?

A

Mitral stenosis

56
Q

Which murmur increases with inspiration?

A

Tricupsid regurgitation

57
Q

Which murmur has associated findings of prominent JVD and heart failure?

A

Tricupsid regurgitation

58
Q

Minor vs. Major - when do discontinue warfarin?

A

3-5 days prior to major surgery
Heparin can be used as a bridge
try to avoid rebound hypercoagulation

59
Q

What medications should be avoided w/mitral stenosis?

A
  • Ketamine
  • Histamine releasing NMBs (pancuronium, atracurium)
  • Morphine (releases histamine)
60
Q

True/False.. Aortic stenosis is always associated with aortic regurge

A

True

Physical & Health Assessment COPY - Grayson (24 decks)

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