Valvular Heart Diseases Flashcards
Goal for Mitral Stenosis
SLOW, TIGHT, FULL
Avoid SINUS TACHYCARDIA; avoid INCREASES IN BLOOD VOLUME, avoid decreases in SVR, avoid hypoxemia and hypoventilation, maintain CONTRACTILITY.
Drugs to use for mitral stenosis?
Etomidate, beta blockers, ccb, phenylephrine, opioids and lido to blunt DVL (GOAL: SLOW, TIGHT, FULL)
Drugs to avoid for mitral stenosis?
Ketamine, Pancuronium, atracurium, mivacurium, propofol, Spinals, Desflurane- decreases SVR and increases HR. (histamine releasers and wide swings in HR and SVR.
GOAL: SLOW, TIGHT, FULL
Goal for Mitral Regurgitation?
FAST, FULL, FORWARD
- avoid decreases in HR
- avoid increases in SVR (avoid neo)
- Monitor V wave
- Minimize drug induced myocardial DEPRESSION. (low mac)
Drugs to AVOID in mitral regurg?
CCB, BB, high MAC (unless LV function OK), high dose opioids, Desflurane
FAST, FULL, FORWARD
Drugs OK to give in mitral regurg?
ETOMIDATE; ISOFLURANE +NO (if LV function is OK), if severed LV dysfunction, high opioids ok; vec, roc, cis, pan; dobutamine, isoproterenol, FLUIDS (KEEP FULL!)
FAST, FULL, FORWARD
Goals for Aortic Stenosis?
NSR, TIGHT, FULL
maintain NSR, normal high HR, high SVR, optimize intravascular fluid volume.
Things to avoid in aortic stenosis
spinal or epidurals, anything that decreases CO
NSR, TIGHT, FULL
Things OK in aortic stenosis
Etomidate, vec, roc, cis, N2O + low VA + opioids, GA.
NSR, TIGHT, FULL
Goals in aortic regurg?
avoid decreases in HR, avoid increases in SVR, minimize myocardial depression
Things to use in aortic regurg?
Etomidate, Ketamine, IV fluid/BLOOD, atropine/glyco, N2) and VA if no severe LV dysfunction. IF there IS myocardial dysfunction, can use opioid alone. ISO and Sevo
Things to avoid in Aortic Regurgitation?
Des, N20 (per ladan), bradycardia,
