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(Steele) Physical & Health Assessment (Spring 2025) > 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

increased flow across a normal valve

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4
Q

Systolic murmurs are caused by what valve pathologies?

A
  • Aortic/Pulmonic Stenosis
  • Mitral/Tricuspic Regurgitation

IF hear systolic murmur stop and assess further

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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

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9
Q

What characterizes holosystolic murmurs?

A

S1 and S2 merging

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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? (6)

A
  • Exertional dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Pulmonary edema
  • Pulmonary HTN
  • A-Fib
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23
Q

How is mitral stenosis treated? (4)

A
  • Rate control (80bpm goal)
  • ↓LAP (diuretics)
  • Anticoagulation
  • Surgical correction
24
Q

What EKG abnormalities are common with mitral stenosis?

A
  • Notched P waves
  • A-Fib
25
What Echocardiogram abnormalities are common with mitral stenosis?
- Calcification - Left atrial thrombus **- Left atrial enlargement**
26
What are the anesthetics goals for a patient with mitral stenosis?
Maintain normal parameters for HR, volume status, and afterload.
27
Maintain BP and SVR in MS patients with what 2 drugs?
Vaso and Neo
28
Avoid these drugs for induction of MS pt
Ketamine - tachy histamine releaseing NMBs - pancuronium, atracurium - cause hypotension and tachycardia
29
What is more common, mitral stenosis or regurgitation?
Regurgitation (2% of US population)
30
What type of murmur would be auscultated with mitral regurgitation?
Holosystolic murmur at the cardiac apex radiates to left axilla
31
What less invasive cath lab procedure is used to treat mitral regurgitation?
Mitra-clip
32
What β-blocker is preferred for mitral regurgitation? What drug is also commonly used for BP control?
Carvedilol ACE - Inh
33
What are the anesthetic goals for mitral regurgitation patients?
- Improve LV stroke volume - Decrease Regurg
34
What heart rate would you want to maintain with mitral regurgitation?
Normal to slightly increase HR *Bradycardia will increase LV volume overload.*
35
What type of pathology would cause early-life development of aortic stenosis?
Bicuspid Aortic Valve
36
What is the normal surface area of the aortic valve?
2.5 - 3.5 cm²
37
What is the surface area of a severely stenotic aortic valve?
< 1 cm²
38
What pathology would be expected for a systolic or mid-systolic murmur hear in the right upper sternal border?
Aortic Stenosis
39
What symptoms are seen with aortic stenosis becomes critical?
- Angina - Syncope - Dyspnea on exertion
40
____% of aortic stenosis patients will die within three years without a valve replacement
75%
41
What EKG characteristics would be seen for a patient with aortic stenosis?
- ST depression - T-wave inversion
42
What non-surgical treatments are available for aortic stenosis?
- Balloon valvotomy for younger patients - TAVR
43
What type of anesthetic technique is generally better for patients with aortic stenosis?
General Anesthesia
44
NO cardiac surgry will be done on the pt who has any of these 4 criteria. TAVR could be done instead
1. Age over 65 2. Transfemoral TAVR if feasible 3. Aortic valve must be trileaflet and 4. absense of high risk anotomical features like: adverse aortic root low coronary ostia height, or LV outflow tract calcification
45
Etomidate is commonly used for induction in pts with
Aortic Stenosis
46
What are common causes of chronic aortic regurgitation?
- Endocarditis/rheumatic fever - Bicuspid AV - Anorexigenic drugs
47
4 things for aortic stenosis treatment to remember
**1. non-cardiac surgery 2. Ascertain severity 3. Prevent hypotension 4. Maintain normal HR**
48
What are the two common causes of acute aortic regurgitation?
- Endocarditis - Aortic dissection
49
What two factors determine the degree of regurgitant blood flow from a dysfunctional aortic valve?
- Time available for flow (HR) - Pressure gradient (SVR)
50
What type of murmur would be heard with aortic regurgitation?
Early to mid-diastolic murmur at left sternal border Low pitced diastolic rumble (Austin-Flint murmur)
51
What blood pressure abnormalities are often seen with aortic regurgitation?
- Widened pulse pressure - decreased dBP - Bounding pulses
52
Medical treatment for aortic regurge
Diuretics ACE-Inh CCB
53
Anesthetic goals for Aortic Regurge (5)
maintian forward LV Stroke volume avoid brady** (>80)** Avoid increased SVR Minimize myocardial depression | FAST, FORWARD, FULL
54
MURMUR location chart if time
55
Ensure _____ is maintained and adequate for aortic stenosis pts
**Heart Rate** Use Neo, not Epi

(Steele) Physical & Health Assessment (Spring 2025) (30 decks)

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