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Valvular Heart Problems Flashcards

1
Q

What 3 levels can aortic stenosis occur?

A
  • Valvular
  • Subvalvular
  • Supravalvular
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2
Q

What is the most common valvular problem?

A

Aortic stenosis

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3
Q

In aortic stenosis, a valvular problem occurs where?

A

Leaflets

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4
Q

name the 3 types valvular aortic stenosis.

A
  • Calcification and fibrosis of normal valve
  • Calcification and fibrosis of congenital bicuspid AV
  • Rheumatic
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5
Q

What caused the decline in rheumatic aortic stenosis?

A

antibiotics

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6
Q

How are the 3 leaflets of the aortic valve named?

A

Coronary artery

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7
Q

What is a normal aortic valve opening?

A

2-4 cm²

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8
Q

What is opening of a aortic valve with severe stenosis?

A

<1 cm²

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9
Q

What is surgical indication for aortic stenosis?

A

<1 cm²

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10
Q

What 2 things is the aortic valve between?

A

Left Ventricle and Aorta

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11
Q

Normally the aortic valve has how many leaflets?

A

3

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12
Q

In a normal Left Ventricle, the mean peak gradient is what?

A

> 50 mmHg

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13
Q

What may underestimate the severity of aortic stenosis?

A

Low peak gradient from poor left ventricular function.

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14
Q

Chronic LV pressure overload leads to what?

A

Left Ventricle Hypertrophy

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15
Q

In aortic stenosis left ventricular hypertrophy is need to do what?

A

Decrease wall stress

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16
Q

What 3 problems arise with left ventricular hypertrophy?

A
  • ↓ diastolic compliance
  • ↓ coronary blood flow
  • imbalance of cardiac O2 supply and demand
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17
Q

What 2 things does ↓ diastolic compliance lead to?

A

↑ LVEDP

↑ LVEDV

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18
Q

Overall the major concern with aortic stenosis is what?

A

Myocardial ischemia

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19
Q

Myocardial ischemia in aortic stenosis is related to what 4 things?

A
  • LVH
  • ↑ wall stress
  • ↓ coronary perfusion
  • ↓ coronary flow reserve
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20
Q

What is the most crucial goal in Aortic Stenosis?

A

Sinus Rhythm

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21
Q

In aortic stenosis you must _______ any SVT’s promptly.

A

Cardiovert

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22
Q

What is the optimal HR in aortic stenosis?

A

60-80

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23
Q

What does tachycardia in artial stenosis lead to?

A

Ischemia & Ectopy

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24
Q

What does bradycardia lead to in aortic stenosis?

A

Low CO due to fixed stroke volume.

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25
Q

In aortic stenosis Adequate ________ is essential, but difficult to predict due to ________.

A

Preload

Diastolic dysfunction

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26
Q

In aortic stenosis you need to maintain ________ and avoid _________.

A

Contractility

Myocardial depressants

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27
Q

In aortic stenosis, hypotension needs to be treated quickly with what 2 things?

A

Phenylepherine

Trendelenburg

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28
Q

Trendelenburg increases what?

A

Preload

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29
Q

In aortic stenosis what drugs are used to maintain coronary perfusion pressure?

A

Alpha agents

  • Phenylepherine
  • Norepinephrine
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30
Q

What type of anesthesia should be avoided with aortic stenosis?

A

Spinal and epidural

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31
Q

Why should spinal and epidural anesthesia be avoided in aortic stenosis?

A

Decrease in preload

Increase in HR

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32
Q

What is the most crucial time in aortic stenosis surgery?

A

Induction

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33
Q

What monitoring in needed for aortic stenosis?

A

Standard and pre-induction A-line

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34
Q

How would you premedicate aortic stenosis patients?

A
  • Young and anxious get Benzos

- Old and frail get little or no benzos

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35
Q

After aortic stenosis bypass a noncompliant heart is dependent on what?

A

Stable rhythm

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36
Q

In weaning aortic stenosis off bypass what would you give for LV dysfunction?

A

inotropes

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37
Q

What is a myomectomy?

A

surgery to remove the septal muscle of enlarged heart

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38
Q

How would you treat a subaortic or cavitary obstruction after a aortic valve replacement?

A

Volume
Beta blockers
Myomectomy

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39
Q

Name 3 types of aortic regurge.

A
  • Aortic root dilation
  • Deformed cusps
  • Cusp Prolapse
40
Q

Name the 7 causes of aortic root dialtion w/ aortic regurge.

A
  • HTN
  • Aortic dissection
  • Cystic necrosis
  • Marfans
  • Syphilitic
  • Ankylosing spondylitis
  • Osteogensis imperfecta
41
Q

Name 3 things which cause deformed cusps in aortic regurge.

A
  • Rheumatic
  • Infective endocarditis
  • Bicuspid valve
42
Q

What typically causes aortic regurge cusp prolapse?

A

Aortic dissection

43
Q

Regurge are considered what type of problems?

44
Q

Stenotic are considered what type of problem?

45
Q

T/F aortic regurge is symptomatic?

A

F-Asymptomatic

46
Q

In aortic regurge, how does the LV maintain systolic function?

A
  • Dilation

- ↑ compliance

47
Q

What is the main problem with aortic regurge?

A

LV volume and pressure overload

48
Q

In the latter stage of aortic regurge, the LV decompensates and what happens?

A
  • CHF
  • Arrhythmias
  • Sudden death
49
Q

T/F aortic regurge develops concentric hypertrophy.

A

F- Eccentric Hypertrophy

50
Q

What is the problem w/ acute aortic regurge?

A

LV can not compensate (dilate) quickly enough.

51
Q

What does acute aortic regurge lead to?

A

Pulmonary edema

52
Q

What is needed with acute aortic regurge?

A

emergency surgery

53
Q

What is t he optimal HR for aortic regurge?

54
Q

Why should you avoid bradycardia with aortic regurge?

A

-↑ regurgitation

55
Q

Why do you need to avoid afterload with aortic regurge?

A

-Pressure gradient

56
Q

What meds are needed for aortic regurge?

A
  • inotropes

- Vasodilator (nipride)

57
Q

What is contraindicated in aortic regurge?

A

Balloon pump

58
Q

What anesthetic technique can be useful in aortic regurge if LV is impaired?

A

Narcotic based

59
Q

Why would ketamine be used in acute aortic regurge?

A

maintain HR

60
Q 
Pressure = \_\_\_\_\_\_\_\_\_\_
Volume  = \_\_\_\_\_\_\_\_\_\_\_
A

Hypertrophy

Dilation

61
Q

What usually causes mitral stenosis?

62
Q

What happens to the mitral valves leaflets during stenosis?

A
  • Thickening
  • Calcification
  • Fusion
63
Q

What are the surgical indications for mitral stenosis?

A
  • Opening <1cm²
  • NYHA class 3/4
  • Left atrium clot
64
Q

In mitral stenosis, what is the main problem?

A

-Pressure gradient between LA and LV.

65
Q

In mitral stenosis, ↑ left atrial pressure causes what?

A
  • Pulmonary HTN

- Left atrial enlargment

66
Q

Left atrial enlargement causes what?

67
Q

Pulmonary HTN causes what?

A
  • Right ventricular dysfunction and enlargment

- Tricuspid regurge

68
Q

What are the 3 hemodynamic goals of Mitral Stenosis?

A
  • Preserve Sinus Rythm
  • Avoid Tachycardia
  • Avoid worsening pulmonary HTN
69
Q

What 5 things should you avoid with pulmonary HTN?

A
  • Hypercarbia
  • Acidosis
  • Hypothermia
  • Sympathetic activation
  • Hypoxia
70
Q

Why does hypercarbia and acidosis worsen pulmonary HTN?

A

Constricts pulmonary arteries

71
Q

Anesthetic management of Mitral stenosis.

A
  • Benzos (HR)
  • O2 (pulmonary HTN)
  • Control HR
72
Q

in mitral stenosis PA pressures can be ___________ due to LVEDP and LVEDV

A

Underestimated

73
Q

What is the most effective drug with Mitral Stenosis

A

Esmolol

  • 10-20 mg bolus
  • 50-100 mcg/kg/hr
74
Q

What 2 meds should be avoided with mitral stenosis and why?

A
  • N2O (pulm HTN)

- Panc (tachy)

75
Q

What drugs should be used if preop pulm HTN or RV dysfunction in mitral stenosis?

A

Milrinone

Nitric Oxide

76
Q

4 causes of mitral regurge

A
  • Myxomatous degeneration
  • Ischemia
  • Endocarditis
  • Trauma
77
Q

Mitral regurge is ________ overload of the _________.

78
Q

LV overload in mitral regurge leads to what?

A

-Massive LA dilation w/ arrhythmias.

79
Q

When Mitral regurge valve is repaired, what do you need to be aware of?

A

LV dysfunction is unmasked. Flow now going forward, heart not used to pumping that hard.

80
Q

Severity of mitral regurge is based on what?

A
  • Pressure gradient LA - LV
  • Size of regurge orifice (ERO)
  • Duration of systole
81
Q

When is pressure gradient between LA and LV lowest in mitral regurge?

A

Early in the disease, before LA expands to handle more volume

82
Q

3 goals in mitral regurg.

A
  • Vasodilators
  • High HR
  • Maintain contractility
83
Q

How do vasodilators help mitral regurge?

A
  • ↓ afterload
  • ↓ regurge fraction
  • ↑ forward flow
84
Q

Why might inotropes and vasodilators be needed after mitral regurge valve surgery?

A
  • Lessen afterload

- Improve forward flow

85
Q

Why is MV repair beneficial to MV replacement?

A
  • Preserve papllary and chordae

- Enhanced LV function

86
Q

Primary Causes for tricuspid regurge?

A
  • Rheumatic
  • Carcinoid
  • Ebstein’s
  • Trauma
  • Endocarditis
87
Q

Secondary causes of tricuspid regurge?

A
  • Chronic RV dilation

- Mitral valve disease

88
Q

It is very rare to see a tricuspid valve problem w/o ________ valve problem.

89
Q

Right atrial pressure rise only with end stage disease why?

A

RA is very compliant

90
Q

What worsens tricuspid regurge?

A

Pulm HTN due to mitral vale disease increases right ventricle afterload.

91
Q

What cause paradoxical motion of the LV septum?

A

Right ventricle enlargement

92
Q

What problems arise from LV pradoxical movement?

A

Impaired LV filling and compliance

93
Q

Right heart failure causes what?

A

Hepatomegaly and ascites

94
Q

How do you treat tricuspid regurge?

A
  • treat mitral valve problem
  • Avoid pulm HTN and PVR
  • Normal to high preload
95
Q

WHY avoid beta blockers with tricuspid regurge?

A

Worsen pulm HTN

96
Q

What monitor may be difficult to place with tricuspid regurge?

A

PAC (swan)

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