Valvular Heart Disease EXTRAS Flashcards
What is the most sensitive indicator of left ventricular myocardial ischemia?
A) Wall motion abnormalities on echo
B) Appearance of V waves on the PCW tracing
C) ST segment changes in V5
D) Decrease in cardiac output
A) Wall motion abnormalities on echo
Cardiac Tamponade is associated with?
A) pulsus alternans
B) Pulsus tardus
C) pulsus parvus
D) pulsus paradoxus
D) pulsus paradoxus
The MAP in a patient with a blood pressure of 180/60 mmHg is?
A) 90
B)110
C)100
D)120
C) 100
Which of the following would be the best intraoperative TEE view to monitor for myocardial ischemia?
A) Midesophageal 4 chamber view
B) Midesophageal long axis view
C) Transgastric mid-papillary left ventricular short axis view
D) Midesophageal two chamber view
C) Transgastric mid-papillary left ventricular short axis view
Which of the following medications blocks angiotensin at the receptor?
A) losartan
B) lisinopril
C) terazosin
D) spironolactone
A) losartan
Sildenafil belongs to the same class of drug as which of the following?
A) yohimbine
B) hydralazine
C) milrinone
D) enalapril
C) milrinone
What is the minimum amount of time after angioplasty with a drug eluting stent that DAPT is continued before elective surgery?
A) 3 months
B) 1 year
C) 6 months
D) 18 months
B) 1 year
The effects of clopidogrel can be reversed with?
A) FFP
B) Aprotinin
C) Factor VIII
D) None of the above
D) None of the above
You made an infusion of dopamine with 200 mg dopamine in 250 mL 800mcg/mL. What is the rate for 5 mcg/kg/min in a 70 kg patient?
A) 10 mL/hr
B) 20 mL/hr
C) 16 mL/hr
D) 26 mL/hr
D) 26 mL/hr
Severe aortic stenosis is associated with a valve area of less than how many cm^2?
A) 1
B) 4
C) 1.5
D) 40
A) 1
_____ regurgitation d/t ischemic heart disease increases mortality.
Mitral
A compensatory increase in sympathetic nervous system activity may manifest as _____, __________, and resting ________.
anxiety, diaphoresis, tachycardia
What is a physiologic murmur?
A murmur that is primarily d/t physiologic conditions outside the heart, as opposed to the heart itself.
What is the only murmur that can be considered physiologic or functional?
midsystolic
What will you do if you auscultate anyone with a systolic murmur?
STOP. It’s valid to delay the case for a cardiac workup
What type of murmur radiates to the carotids? What pathology is it associated with?
midsystolic murmur. Aortic Stenosis
What type of murmur radiates to the axilla? What pathology is it associated with?
holosystolic murmur. Mitral regurgitation
When referring to murmurs…. what does crescendo mean?
gradually getting louder
When referring to murmurs… what does decrescendo mean?
gradually getting softer
What murmurs will increase with standing or valsalva maneuvers?
What murmur decreases with standing or valsalva meneuvers?
Mitral prolapse, hypertrophic cardiomyopathy.
Aortic stenosis
What murmur increases with tachycardia?
Mitral stenosis
What murmur increases with inspiration?
tricuspid regurgitation
What murmur is associated with a midsystolic click?
Mitral valve prolapse
What murmur is associated with an ejection click? A midsystolic click?
Ejection click = aortic stenosis
Midsystolic click = mitral stenosis
Is warfarin still discontinued in mechanical heart valve patients before minor surgery? Major surgery?
Minor surgery = no, as long as bleeding risk is minimal
Major surgery= yes, transition w/unfractionated heparin until the day before or day of surgery. Resume heparin post-operatively and transition back to warfarin
When referring to the left atrium/left ventricle, what is the sub-valvular apparatus?
LV free wall, two papillary muscles, and chordae tendineae. The sub-valvular apparatus prevents mitral valve prolapse during systole.
What type of MI can cause ischemia and infarction of the papillary muscles?
Inferior MI
With severe mitral stenosis, any additional stress such as fever or sepsis may precipitate what?
Pulmonary edema
What pressor agents are the agents of choice in maintaining SVR and BP in patients with mitral stenosis?
Phenylephrine and vasopressin
Why is pancuronium avoided in many valvular diseases?
Histamine release
What is a common cause of acute mitral regurgitation?
Myocardial ischemia/infarction which causes papillary muscle dysfunction/rupture
Is afterload reduction for treating mitral regurgitation appropriate?
Absolutely
What are some risks associated with bicuspid aortic valve?
-aortic stenosis
-aortic aneurysms
-aortic dissection
Is ROSC likely in a coding patient with aortic stenosis?
No
