34. Structural Cardiac Flashcards
(121 cards)
1
Q
preop testing for valvular anomalies
A
TEE
TTE
heart Cath
Echo
2
Q
regurgitant valve
A
backflow
3
Q
stenotic valve
A
restricting blood flow
4
Q
valvular symptoms
A
low MET level
fatigability
pedal edema
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
angina
TIA/CVA
5
Q
Left sided valvular anomaly
A
pulmonary rales
S3 gallop
6
Q
right sided valvular anomally
A
jugular vein distension
pedal edema
7
Q
best physical exam indication for valvular anomaly
A
auscultation
8
Q
advanced exams for valvular anomalies
A
TEE
TTE
Right heart cath
9
Q
heart valve order
A
toilet paper my ass
Tricuspid
Pulmonic
Mitral
Aortic
10
Q
vena contracta
A
diameter of stream is least
fluid velocity is max
11
Q
when is vena contracta measured
A
regurgitant valves
12
Q
EROA
A
effective regurgitatnt orifice area
13
Q
EROA is measured by
A
TEE doppler
PISA method
14
Q
Annulus
A
fibrous ring of tissue that accommodates the dynamic myocardium and valve leaflets
15
Q
how is annular diameter measured
A
TEE
16
Q
what HR is ideal for regurgitation?
A
Faster HR
– allows for more forward flow
– limits backflow
17
Q
what HR is ideal for stenosis
A
Slower HR
– increases flow across small valve
18
Q
RH valves
A
Tricuspid
pulmonic
19
Q
tricuspid stenosis SE
A
Right atrial dilation
- arrythmias
- jugular venous distension
- ascites
- peripheral edema
- hepatomegaly
- anasarca (general swelling)
20
Q
what is tricuspid stenosis associated with
A
RHD
valvular disorders
21
Q
tricuspid stenosis anesthetic managment
A
high preload
adequate contractility
22
Q
causes of tricuspid regurge
A
endocarditis
carcinoid syndrome
ebstein anomaly
23
Q
secondary causes of tricuspid regurge
A
RV dilation
severe PHTN
24
Q
tricuspid regurge symptoms
A
RHF
fatigue
edema
ascites
25
tricuspid regurge treatment
decr fluids
decr salt
diuretics
decr PHTN
26
what drugs decr PHTN
endothelin receptor antag
PDE inhibitors
27
tricuspid regurge anesthetic
manage PHTN
manage RHF
mx volume status
normal HR
28
how do you manage PHTN
avoid hypoxia
avoid fluid overload
avoid hypercarbia
29
how do you manage RHF
milrinone
dobutamine
30
when are neuraxial techniques CI for tricuspid regurge
with tricuspid regurge and RHF
31
pulmonic stenosis is most common in what pt population
peds
32
pulmonic stenosis symtoms
asymptomatic until severe
33
pulmonic stenosis managment
preserve RV preload
preserve contractility
avoid PVR increases
34
pulmonic regurg primary causes
endocarditis
carcinoid syndrom
iatrogenic
35
iatrogenic causes of pulmonic regurge
catheter
surgery issues
36
seconday cause of pulm regurge
pulmonary artery dilation
37
pulmonic regurge management
decr PHTN
mx RV function
38
LH valves
mitral
aortic
39
cause of mitral stenosis
rheumatic fever
40
mild-mod mitral stenosis
slight incr LA P/V
41
what makes symptoms worse in mild-mod mitral stenosis
incr in HR
42
severe mitral stenosis
incr LA P/V at rest
43
what increases mitral stenosis symptoms
sepsis
fever
emotional stress
pregnancy
44
mitral stenosis symptoms
PHTN
PHF
exertional dyspnea
Afib
Ortner syndrome
thromboemolism risk
45
ortner syndorm
LA compression on RLN
46
ortner syndrome SE
chest/back/epigastric pain
cough
wheeze
stridor
47
mitral stenosis physical exam
rales
peripheral edema
ascites
incr jugular venous pressure
mitral facies (patches on cheeks)
48
mitral stenosis heart impacts
LA hypertrophy
R heart changes
interstitial fibrosis
49
mitral stenosis management
optimize HR
prevent decr CO
prevent pulm edema
treat Afib or arrythmias
50
is epidural or spinal better for mitral stenosis
epidural
51
how do you prevent pulmonary edema
decr preload
== avoid fluid overload
52
what drug should you avoid in mitral stenosis
ketamine
-- incr PVR
-- decr SVR
--hypoxia
-- hypercarbia
53
causes of acute mitral regurge
ischemia of papillary muscle
papillary muscle rupture
54
causes of chronic mitral regurge
annular dilation
endocardidits
chordae incopetence
myxoma
55
myxoma
pedunculated benign heart growth
most common in atria
56
mitral regurge CO
decreased
57
mitral regurge
LV hypertrophy
LHF
Pulmonary edema
RHF
58
mitral regurge symptoms
DOE
fatigue
59
mitral valve prolapse
valve leaflet tents up into left atrial cavity
60
cause of mitral valve prolapse
connective tissue disorder
- ehler danos
- marfans
61
most common precursor to mitral regurge
mitral valve prolapse
62
treatment for mitral valve prolapse
valve repaire
valve replacement
mitraclip
63
mitral regurge management
fast HR
full CO
forward stroke volume
decr afterload
64
how can you reduce afterload
neuraxial technique (epidural)
65
how do you correct LV dysfunction
vasodilator
inotropic agent
66
what should you avoid in mitral regurge
sympathetics (incr SVR)
hypoxia
hypercarbia
(incr PVR)
67
what decr sympathetics
opioids
68
most problematic valve dysfunction
aortic stenosis
69
causes of aortic stenosis
rheumatic fever
atherosclerosis
HTN
hypercholesterol
diabetes
smoking
male
age
70
aortic stenosis symptoms
syncope
DOE
angina
71
when does survival start to be threatened with aortic stenosis
once symptoms onset
72
TAVR
transfemoral aortic valve replacement
73
what age is TAVR better for
>65
74
when is TAVR more risky
aortic root complication
low coronoary ostia height
LVOT calcification
75
aortic stenosis managment
mx preload (normovolemia)
normal HR
maximize LV
avoid hypotension
avoid SVR decr
76
is regional good for aortic stenosis
no
77
causes of aortic regurge
leflet development anomaly
obstruction
annular dilation
78
types of obstructions
calcification
myoxma
endocarditis
79
type of annular dilation
aortic root
LVOT
connective tissue disorder
80
aortic regurge
incr LV EDV/EDP
81
chronic aortic regurge
LV hypertrophy
82
acute aortic regurge
ischemia
83
what should you mx in aortic regurge
forward LV stroke volume
84
what should you avoid in aortic regurge
bradycardia
abrupt SVR incr
volume overload
85
should you wakeup be fast or slow with aortic regurge
slow
- aovid SVR incr
86
should you use high or low VA with aortic regurge
low VA
- high induces myocardial contractility depression
87
infective endocarditis
presents most like a regurgitant valve
-- sometimes stenotic
88
cause of IE
frequent exposure of bacteria daily
89
IE high risk pts
prosthetic heart valves
annuloplasty
history of IE
cyanotic HD w/shunts
cardiac transplant
90
IE high risk procedures
dental
respiratory tract
infected skin
musculoskeletal
total joints
91
cause of HOCM
autosoma dominant
92
HOCM symptoms
death
DOE
palpitations
chest pain
tachydysrhthmias
HF
93
HOCM can be induced with
rest
valsalva
exercise
94
HOCM mimics
mitral regurge
aortic stenosis
95
HOCM
enlarge IVS
LVOT
myocardial hypertrophy
diastolic dysfunction
prolonged relaxation
ischemia
dysrhthmias
96
diastolic function causes
decr CPP
97
is deep or awake extubation better with HOCM
deep
98
what should you avoid in HOCM
incread outflow obstruction:
- incr myocardial contractility
- decr preload
- decr afterload
99
what should you favor in HOCM
decreaed outflow obstruction:
- decr myocardial contractility
- incr preload
- incr afterload
100
what incr myocardial contractility
beta stimulation
digitalis (digoxin)
101
what decreases preload
hypovolemia
vasodilators
tachycardia
PPV
102
what decreases afterload
hypotension
vasodilators
103
what decr myocardial contractility
beta blockade
VA
CCB
104
what incr preload
hypervolemia
bradycardia
105
what incr afterload
HTN
alpha stimulation
106
what drugs are CI with HOCM
ephedrine
dopamine
dobutamine
107
can you use regional with HOCM
yes - plan ahead for impactys
108
what can induce LVOT post-op
pain
anxiety
shivering
hypoxia
hypercarbia
109
broken heart disease
AKA takotsubo
stress cardiomyopathy
110
how do you manage broken heart disease
like HOCM
111
when do you use intraortic balloon pump
if stress cardiomyopath is prolonged w/negative effects
112
what gas is used in IABP
He
113
what EF triggers need for cardiac transplant
<20%
114
p wave is transplanted heart
2
-1st is pt
- 2nd is new heart
115
is elevated or slow HR normal after transplant
slightly elevated
116
do transplanted hearts respond to alpha and beta stimulation
yes
- indirect mechanisms are delayed
117
does glyco/atropine work on transplanted heart
no
118
transplanted heart
no sympathetics
no parasympathetics
no sensory
silent MI
119
cyclosporine
anti rejection meds
HTN
nephrotoxicity
120
tacrolimus
nephrotoxic
121
transplanted heart is dependent on
preload
