Brainscape's Knowledge GenomeTM

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


See full index

COEXISTING > VALVULAR HEART DISEASES > Flashcards

VALVULAR HEART DISEASES Flashcards

1
Q

valve lesions that are: pressure overload vs. volume overload

A

pressure overload = mitral stenosis, aortic stenosis

volume overload = mitral regurgitation, aortic regurgitation

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

preoperative evaluation goals of patients w/ valvular heart disease

A
  1. ascertain the severity of the disease
  2. the degree of impaired contractility
  3. presence of associated major organ system disease
  4. recognition of compensatory mechanisms
  5. evaluation of drug therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

New York Heart Association Functional Classification of Patients with Heart Disease

A

Class I = asymptomatic
Class II = symptoms w/ ordinary activity but comfortable at rest
Class III = symptoms w/ minimal activity but comfortable at rest
Class IV = symptoms at rest

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

systolic murmur

A

could reflect:

  • stenosis of aortic or pulmonic valves
  • incompetence of mitral or tricuspid valves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

diastolic murmur

A

could reflect:

  • stenosis of mitral or tricuspid valves
  • incompetence of aortic or pulmonic valves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

angina in pt w/ valvular dz

A

not necessarily representative of CAD, but the two dz often co-exist

  • increased myocardial O2 demand 2/2 ventricular hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

complications associated w/ prosthetic heart valves

A
  • valve thrombosis
  • systemic embolization
  • structural failures
  • hemolysis
  • paravalvular leak
  • endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

management of anticoagulation pre-operatively in pts w/ prosthetic valves

A
  • continue anticoagulation in minor surgery

- bridge w/ heparin (d/c warfarin 3-5 days preop) for major surgery

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

SBE guidelines

A

Conditions

  • prosthetic valve
  • previous endocarditis
  • congenital heart disease: unrepaired, repaired w/ prosthesis w/in 6 months, or prosthetic repair w/ residual defects
  • cardiac transplantation w/ development of valve problems

Procedures

  • dental w/ perforation of oral mucosa
  • invasive of respiratory tract
  • invasive of infected skin/musculoskeletal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

mitral stenosis: cause

A

rheumatic fever (by FAR most common)

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

mitral stenosis: symptoms

A

as a result of high LAP

  • DOE
  • orthopnea
  • paroxysmal nocturnal dyspnea

SV not impaired at rest 2/2 compensatory increased LAP, but SV decreases w/ tachycardia or afib

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

mitral stenosis: valve gradient

A 
mild = 6mmHg
moderate = 6-10mmHg
severe = >10mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mitral stenosis: symptomatic at what size & transvalvular pressure?

A

normal mitral valve orifice = 4-6cm^2
- symptomatic at <50%

at valve area <1cm^2:

  • mean LAP of 25mmHg is required to maintain CO
  • chronic pulm HTN is likely if mean LAP >25mmHg
  • -> predispose to pulm edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

mitral stenosis: what are these pts more at risk for?

A
  • pulmonary edema
  • decreased CO w/ exertion or hyperdynamic states
  • thromboembolic events
  • afib 2/2 LA enlargement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mitral stenosis: tx

A
  • control HR to allow for LV filling (prevent increases in LAP)
  • anticoagulation w/ concurrent afib
  • diuretics if pulm edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

mitral stenosis: anesthetic management

A

prevent events that can decrease CO or produce pulmonary edema

  • avoid tachycardia
  • cardiovert or at least rate control if pt develops afib
  • avoid excessive periop fluid admin, trendelenburg (precipitate CHF)
  • avoid sudden SVR decrease (compensatory tachycardia not tolerated); give sympathomimetic like phenylephrine
  • maintain contractility (used balanced technique, not just volatiles)
  • avoid light anesthesia
17
Q

mitral regurgitation: cause

A
  • rheumatic fever (usually associated w/ mitral stenosis
  • ischemic heart disease
  • papillary muscle dysfunction
18
Q

mitral regurgitation: pathophysiology

A

portion of every SV goes back into the LA

  • -> LA volume overload & pulmonary congestion
  • -> decreased SV = decreased CO
19
Q

mitral regurgitation: severity dependent on?

A
  1. size of mitral valve orifice
  2. heart rate (determines duration of ventricular ejection)
  3. pressure gradients across the mitral valve
20
Q

mitral regurgitation: severity as indicated by area of MR jet

A 
mild = <3cm^2 --> 20-30% regurgitation
moderate = 3-6cm^2 --> 30-50% regurgitation
severe = >6cm^2 --> >55% regurgitation
21
Q

what will you see on the PAOP waveform w/ mitral regurgitation?

A

V WAVE

- size of V wave correlates w/ magnitude of the mitral regurgitation

22
Q

mitral regurgitation: management of anesthesia

A

improve forward LVSV; decrease regurgitant fraction

  • prevent bradycardia
  • prevent SVR increases (tx w/ nitro)
  • minimize myocardial depression (tx w/ inotrope)
  • monitor V wave
  • use iso/des/sevo = decrease SVR, comp HR increase, minimal cardiac depression
  • can use opioid if LVF, avoid bradycardia
23
Q

mitral regurgitation: induction

A

pancuronium +/-? increases HR

  • prevent increase in SVR & HR decrease
24
Q

mitral valve prolapse: pathophysiology

A

prolapse of one or both mitral leaflets into the LA during systole +/- mitral regurgitation

25
Q

mitral valve prolapse: anesthetic management

A

tx like regurg if they have it + take measures to minimize regurg

  • larger ventricle = less prolapse & regurg than smaller ventricle
  • thus take measures to keep LV full
  • -avoid SNS activity
  • -avoid decreased SVR
  • -avoid rapid position changes to upright
    • avoid hypovolemia
26
Q

aortic stenosis: development & risk factors

A

degeneration & calcification of the aortic leaflets, and subsequent stenosis (aging) - those w/ bicuspid aortic valve develop AS earlier

risks

  • systemic HTN
  • hypercholesterolemia
27
Q

aortic stenosis: valve area + pressure gradients

A

normal area = 2.5-3.5cm^2

mild = 1.0-1.5cm^2 + <20mmHg
moderate = 0.8-1.0cm^2 + 20-50mmHg
severe = <0.8cm^2 + >50mmHg
28
Q

aortic stenosis: symptoms & pathophysiology

A

obstruction to ejection of blood into the aorta

  • angina 2/2 increased myocardial O2 requirements (hypertrophy) + decreased delivery
  • syncope 2/2 uncompensated exercise induced decrease in SVR

CLASSIC TRIAD:

  1. angina
  2. syncope
  3. DOA
29
Q

aortic stenosis: anesthetic management

A
  • maintain NSR
  • avoid HR changes (bradycardia or tachycardia)
  • avoid hypotension
  • maintain preload

basically, avoid hypotension or any change that will decrease CO

30
Q

aortic regurgitation: pathophysiology

A

decreased CO 2/2 regurgitation of part of the ejective SV back into the LV = pressure + volume overload

magnitude depends on

  1. HR (time available for regurgitation to occur)
  2. pressure gradient across the aortic valve (determined by SVR)
31
Q

aortic regurgitation: anesthesia management

A

goal: maintain forward LVSV

  • avoid bradycardia (even HR <80)
  • avoid increases in SVR
  • minimize myocardial depression
32
Q

summary of anesthetic management of MS, MR, AS, AR

A 
MS = slow, tight, full
MR = fast, full, forward
AS = normal &amp; full
AR = normal

COEXISTING (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions