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Apex > Vavular Heart Disease > Flashcards

Vavular Heart Disease Flashcards

1
Q

What is the first heart sound?

A

Closure of the mitral and tricuspid valves
Marks the onset of systole
End of LV filling and beginning of isovolumetric contraction

Sound is louder with a vigorous contracting heart

Softer with a poorly contracting heart

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2
Q

What is the second heart sound?

A

Closure of the aortic and pulmonary valves

Marks onset of diastole
End of LV ejection, beginning of PV isovolemic relaxation

Sound louder with hypertension
Softer with hypotension

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3
Q

What is the third heart sound? S3?

A

Flavor or inelastic heart ~ heart failure
Heard after S2
Gallop

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4
Q

What is the fourth heart sound? S4

A

Caused by atrial systole
Heard BeFORE S1

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5
Q

What is the normal area of the aortic valve orifice?

A

2.5-3.5 cm2

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6
Q

What is the aortic valve orifice in severe aortic stenosis?

A

< 0.8 cm2

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7
Q

What is the mean transvalvular pressure gradient that is diagnostic for severe AS?

A

> 40 mmHg

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8
Q

What is the triad of symptoms for Aortic stenosis?

A

SAD

Syncope
Angina
Dyspnea

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9
Q

What Coagulopathy occurs in 90% of patients with severe aortic stenosis?

A

Acquired von Willebrand disease

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10
Q

What is the anesthetic management for Aortic stenosis?

A

Full, Slow, and Constricted

Full: adequate LVEDP to fill non-compliant LV

Slow: NSR (ensure atrial kick), no tachycardia (reduces time to fill)

Constricted: stoke is fixed by stenotic valve ~ hypotension —> decreased in aortic diastolic pressure —> coronary perfusion pressure—> myocardial ischemia

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11
Q

How should providers treat hypotension in patients with aortic stenosis?

A

Alpha 1 agonist ~ increases aortic diastolic pressure —> increases coronary perfusion pressure

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12
Q

Does CPR work for a patient with severe AS?

A

No. It does not generate enough pressure to overcome stenotic valve

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13
Q

What conditions do you want to prevent in aortic regurgitation?

A

Bradycardia (this increases filling time ~ already a problem)

Increased SVR (increased gradient)

Large valve orifice (larger area to leak)

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14
Q

What is the anesthetic management for Aortic regurgitation?

A

Full, Fast, Forward

Full: stoke volume is lost as regurgitant, avoid hypocalcemia

Fast: faster HR reduces diastolic filling time and increases AoDBP and CPP

Forward: blood flows the path of least resistance. Increased afterload increases regurgitant. Lower afterload promotes forward flow.

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15
Q

What change does aortic regurgitation do the arterial line waveform?

A

Bisferiens pulse, wide pulse pressure

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16
Q

What conditions are usually responsible for chronic aortic regurgitation?

A

Valvular calcification
Marfans
Ankylosing spondylitis
Ehler-Danlos syndrome

17
Q

What are the two most common etiologies of mitral stenosis? What are other etiologies?

A

Endocarditis
Calcification

Other: lupus, RA, carcinoid syndrome, left atrial myxoma, congenital defect

18
Q

What are some disease processes that mitral valve stenosis can cause?

A

Increased LA pressure —> increase in pulmonary congestion —> pulmonary HTN —> increased in RV workload —> cor pulmonale

Increased LA volume and pressure —> alters anatomy of atrial conduction system —> afib

19
Q

What is the anesthetic management for mitral valve stenosis?

A

Full, slow, constricted

Full/maintain: LV is chronically underfilled—> decrease in SV and CO BUT hypervolemia increases LAP —> increase in pulmonary congestion

Slow: tachycardia decreases filling time —> decreased time for blood to pass MV into LV (any condition that increases CO or HR will increase LAP and may lead to pulmonary edema)

Constricted: chronically low LV filling —> systemic vasoconstriction to increase SVR and BP (treat with Alpha 1 agonist)

20
Q

What are some causes of mitral insufficiency?

A

Similar to stenosis ~ endocarditis, rheumatic fever, heart disease, papillary muscle dysfunction, valve prolapse, lupus, RA, LV hypertrophy

21
Q

What are some conditions that increase regurgitant volume in mitral regurgitation?

A

Slow heart rate
Increased SVR
Increased pressure gradient LV to LA
Increased size of the orifice

22
Q

What is the anesthetic management for mitral regurgitation?

A

Full, Fast, Forward

Full: not all strobe volume goes to systemic circ, some is lost to LA

Fast: regurge occurs during systole (increases HR reduces time spend in systole, thus reduced regurgitant volume)

Forward: blood flows the path of least resistance. Vasodilation promotes flow

23
Q

What is SAM? Think mitral valve

A

Systolic anterior motion

Where the anterior leaflet of the mitral valve blocks outflow tract (resembles hypertrophic cardiomyopathy)

24
Q

What is the mnemonic for aortic stenosis murmurs?

A

ASSS

Aortic
Stenosis (is a)
Systolic murmur (heard at the)
Sternal (right sternal border)

25
Q

What is the mnemonic for aortic regurgitation murmurs?

A

ARDS

Aortic
Regurgitation (is a)
Diastolic (murmur heard at the right)
Sternal (border)

26
Q

What is the mnemonic for mitral valve stenosis murmurs?

A

MSDA

Mitral
Stenosis (is a)
Diastolic (murmur heard at the)
Apex (of the left Axilla)

27
Q

What is the mnemonic for mitral valve regurgitation murmurs?

A

MRSA

Mitral
Regurgitation (is a)
Systolic (murmur heard at the)
Apex (and left Axilla)

28
Q

What is a TAVR?

A

Transcatheter Aprtic Valve Replacement

Minimally invasive procedure to replace aortic valves in pts with AS

29
Q

What are the three approaches in a TAVR?

A

Transfemoral
Transaortic
Transapical

30
Q

What is unique about the SAPIAN valve for TAVRs?

A

Requires balloon valvuloplasty (to widen valve area)

Requires rapid v-pacing to elicit cardiac standstill during deployment (anticipate profound hypotension ~ consider prophylactic vasopressors)

Apnea is also required

31
Q

What is unique about the COREVALVE

A

No need for valvuloplasty or cardiac standstill (valve is self expanding)

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