Brainscape's Knowledge GenomeTM

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


See full index

SRNAAnatomy II > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

Most common symptoms of valvular disorders:

A

CHF
Angina
Dysrhythmias
Syncope

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

Valvular “Insufficiency”

A

Incomplete closure (causing regurg.)

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

Valvular “Stenosis”

A

Narrowing (restricts flow)

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

• “Mixed” valvular Disorder

A

combination of stenosis & regurg

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

Most common symptoms of rheumatic Fever

A

– Chills, fever, fatigue, migratory arthralgias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. It is ___________ reactivity between ____and _____
  2. Common symptoms: Advancing edge with clearing center_________associated with ___________
  3. Symptoms manifest ______ years after ARF
A
  1. Autoimmune cross reactivity between bacterial and cardiac antigens.
  2. Erythema marginatum; Rheumatic Fever
  3. 10-30 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnosis is established via________
______(valve) is most often affected in ______
What do patients need until adulthood?

A

Jones Criteria
• Mitral valve; Rheumatic Fever
-PCN Prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mitral Stenosis (“MS”)
• Primarily affects_______-
• Almost always_______in origin
– 50% of “MS” pts. have pos. Hx. ARhF ~ 20-30 yrs. prior
• Elderly pt.s – can b caused by ____________
what type of MS is rare ?

A

-females
- rheumatic in origin
-calcification of valve
Congenital

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

Pathologic features of Mitral Stenosis

A

-** Fibrous thickening and calcification of valve leaflets
– ***Fusion of commissures
– Thickening and SHORTENING of CHORDAE tendineae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Normal valve orifice: (mitral ) siz

A

4-6 cm^2

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

Pathologic valve orifice size

A

<2 cm^2

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

Pathologic valve when do you get symptoms

A

< 1.5cm^2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If LA pressure is > 25mmHg – Mitral area is _____cm^2.. If this high pressure can lead to __________

A

< 1 cm2; PULMONARY HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Back pressure to lungs > 25mmHg fluid

A

leaks into interstitial space = Pulmonary Edema

***–> ↓ lung compliance and ↑ W.O.B. (lymphatic can partially compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

***Mitral Stenosis – Anesthesia Goals (MHTN notach)
Maintain: HR?Afterload? rhythm?
Avoid 3 things (HTN)
And avoid drugs that _______such as ____

A

Maintain Normal – Low HR; Normal Afterload; NSR
- Hypervolemia
–Trendelenberg position
–NO2 =↑ Pulm. Vasc. Resist.
- NO Drugs that can cause Tachy. (Pancuronium, Ketamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

For Mitral Stenosis: If pt. has Intra-op. Tachy. Control with:
3 interventions (except
OBD

A
  • *1. Opioids (except Meperidine = Tachy.)
    2. ↑ Depth of Anesthesia
    3: Beta blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

_______and ________okay to use if BP ↓↓ (these don’t ↑ HR) For Mitral Stenosis

A

Phenylephrine or Vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Epidural vs. Spinal which one is preferred and why?

A

Epidural preferred – has less dramatic ↓ in sympathetic

activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mitral Stenosis Treatment (AwBCDD)

A

*** Diuretics for pulmonary congestion
• **β blockers, **Ca++ channel blockers or **Digoxin to control HR
• Anticoagulation if A-fib present
– Warfarin (INR 2.5 – 3.0)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mitral Stenosis :Surgery if symptoms persist with above treatments

A

Percutaneous Ballon VALVULOPLASTY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mitral regurgitation (Mrs3-PMA)___ may be present
• _______murmur heard at apex that radiates to
the_________

A

S3

Pansystolic murmur; axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mitral Regurgitation Treatment (DVABB)

• Acute MR

A

– IV diuretics** to relieve pulmonary edema
– **Vasodilators to reduce resistance to forward flow
• Sodium nitroprusside
– Ace-i, β blockers, Biventricular pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chronic Mitral Regurgitation Treatment

When is surgery recommended?

A

– Surgery recommended before Ejection Fraction <60% to avoid further LV impairment/failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mitral Regurgitation Which Anesthesia preferred.
(remember 2 gs in regurg)
______Optional why not?

A

General
***Neuraxial optional, but dramatic sympathetic decreases
can result in ↓↓↓ BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Aortic Stenosis 3 factors with developement (ACR)

A
  • **Aging: fibrosis/degeneration and calcification

- **Congenital: bicuspid vs. tricuspid↑turbulence/damage – - **RHEUMATIC VALVE DISEASE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Aortic Stenosis Pathophysiology SECOMIASC

A

Stenotic valve = ↓ C.O.
Elevated LV pressures =Ventricular Hypertrophy
Compression of coronary arteries
↓O2 supply; ↑O2 demand
Myocardial ischemia /Angina, Syncope, HF
•Initial compensatory mechanism is ↑LV press.
•AS develops over a chronic course.
•Concentric hypertrophy reduces wall compliance
resulting in a “stiff” LV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

**Aortic Stenosis – Anesthesia Goals (MWAT)

Drugs to avoid VDN

A

Maintain NSR
• Watch for A-fib or Jct. Rhythm (CHF and Hypotension)
• Avoid hypotensive drugs.
– Vasodilators, diuretics, nitroglycerin
**Treat Hypotension aggressively!**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

2 main Causes of Aortic Regurgitation

A

Abnormality of valve leaflets

Dilatation of Aortic Root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

***AR: Abnormalities of valve leaflets (CRE)

A

Congenital (bicuspid)
Rheumatic
Endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

AR: Dilatation of Aortic Root

A

Aortic Aneurysm
Aortic Dissection
Annuloaortic Ectasia
Syphillis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q 
What is the hallmark of Aortic Regurgitation?
What causes it? 
SV is \_\_\_\_\_\_
SBP \_\_\_\_\_\_\_
Aortic Diastolic P \_\_\_\_\_\_\_\_\_
A

Widened pulse pressure is HALLMARK

– From : (3) Increased SV Increased SBP Decreased Aortic Diastolic Pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Decrescendo S2 murmur (S2 AM)

A

– Aortic diastolic press. falls (blue arrow)

– Murmur begins at S2 with regurg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Aortic Regurgitation there is _________And _________ murmur

A

Widened pulse pressure

Descrescendo S2 murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

SLE

A

Affect tissue in the body
CONNECTIVIE TISSUE
LUPUS Causes damage to connective
May cause Choardae tendiane to rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Aortic Regurgitation
Symptomatic pts. w/ (EF) ________
– Offered **surgical correction to prevent progression
– w/o surgery death usually occurs_______

A

ejection fraction <50%:

within 4 yrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q 
Aortic Regurg. – Anesthesia Goals (MRA)
M -->
R-->
A--> 
AVOID WHAT DRUG in AORTIC REGURG and WHY
A

Muscle Relaxants : Pancuronium (vagolytic, maintain increase HR)
**AVOID SUCCINYLCHOLINE (can cause Bradycardia)
Reduce Afterload
Nifedipine or Hydralazine•↓ ventricular reflux; ↑ forward flow
5. For Acute Exacerbations Nitroprusside and Positive inotropic (ex. Dobutamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Tricuspid valve : usually _______rather than ________, resulting from _____enlargement secondary to

A

Usually functional rather than structural, resulting
from RV enlargement 2o to pulmonary HTN,
rather than primary valve ds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Prosthetic Valves

A

↑risk of endocarditis for all type valve replacements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Endocarditis**Acute Bacterial Endocarditis (ABE) FSMH

•4

A

Fulminant infection
• Highly virulent & invasive
• Staph AUREUS usual causative organism
• May occur on previously healthy valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Endocarditis **Subacute Bacterial Endocarditis (SBE) LSO

A

• Less virulent
• Strep VIRIDANS usual causative organism
• Often occurs in pts. w/ prior underlying valve
damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

***ENDOCARDITIS: Pathogenesis requires several conditions: (ETBA)

A
  • 1 – endocardial surface injury
  • 2 – thrombus formation @ injury
  • 3 – bacteria enter circulation
  • 4 – adherence to thrombus or injured surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

***Endocarditis Foreign material (2)

A
  • *Indwelling venous catheter

* *** Prosthetic heart valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

2 Most common sources of endothelial injury:

A
  • Turbulent flow from valvular disease

* Foreign material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

In Endocarditis;
Platelets adhere to ________
Form____________ on _______
__________ stands for _________ endocarditis

A

Platelets adhere to injured endocardial tissue
• Form ** vegetations (Sterile thrombus) on endocardium
and/or valves
• **NBTE – nonbacterial thrombotic endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Complications of Bacteremia: (TEA)

A

Thrombotic or septic emboli
Antigen-Antibody complex deposition
Erosion into conduction system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

***Complications of Bacteremia:

• Thrombotic or septic emboli

A

Infarct target organs (or vasa vasorum causing aortic

aneurysm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

***Complications of Bacteremia: Antigen-Antibody complex deposition

A

Glomerulonephritis, arthritis, vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

***Complications of Bacteremia: Erosion into conduction system

A

Manifest as heart block or other new arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Prenatal shunt is

A

Right to Left

50
Q

***Explain prenatal circulation

A

Prenatal Right heart pressure is Higher than

Left, causing Right to-Left shunt

51
Q

Fetal Circulation has 3 shunts (VeAR FO)

A
  • Ductus venosus
  • Foramen ovale
  • Ductus arteriosus
52
Q

Congenital heart lesions categorized:

A
  • Cyanotic

* Acyanotic

53
Q

– If postnatal shunt is Right-to-Left =

A

Cyanotic

54
Q

If shunt present, Left-to-Right less harmful =

A

Acyanotic

55
Q

Postnatal should be

A

closed

56
Q

***Acyanotic Lesions (ASPAC)

A
  • ASD
  • VSD
  • PDA
  • (Aortic and Pulmonic Stenosis)
  • Coarctation of the Aorta
57
Q

ASD MOST COMMON

Shunt is : ________

A

most common @ Foramen Ovale (failed fusion)

If RA pressure increase secondary to Pulm. HTN or RHF = R-to-L shunt

58
Q

***PDA

A

**Prenatal shunt is R-to-L
• Postnatal becomes L-to-R (2o to ↑ Left pressures)
If Left HF develops, right side pressures dominate
and shunt becomes ***right-to-left

59
Q

PDA Causes volume overload in (3)
• Result:_________
PDA treatment

A

Pulmonary circuit, LA , LV
LV dilation & Left HF

Treatment:
• Indomethacin (block PGE1) or Surgery

60
Q

Coarctation of AORTA associated with____valvve

Blood flow to_____________preserved is diminished.

A

Bicuspid aortic valve
most common assoc’d. abnormality.
head & upper extremities preserved
lower extremity flow

61
Q

Untreated Coarctation of Aorta leads to

A

If uncorrected, causes:
– LV Hypertrophy
– Formation of compensatory collateral intercostal vessels
• Dilation of collaterals erodes undersurface of ribs

62
Q

Coarctation of Aorta when less severe

Treatment of COA is

A

If less severe:
– Claudication in lower extremities following exercise
- SURGICAL CORRECTION

63
Q

What are the 3 Cyanotic Lesions

A
  • Tetralogy of Fallot
  • Transposition of the Great Arteries TGA (EMERGENCY)
  • Eisenmenger Syndrome
64
Q

Four anomalies of TETRALOGY of FALLOT’ (4)

What is the SHUNT direction ?

A
  1. VSD
  2. Pulmonic Stenosis
  3. Aorta from both ventricles
  4. RV Hypertrophy
    Right-to-Left shunt
65
Q

Transposition of the Great Arteries (TGA)

A

• Each great vessel arises from the opposite ventricle
– Aorta from RV; Pulmonary artery from LV
Separates pulmonary & systemic circuits by placing
them in parallel rather than series
• **TGA is lethal after birth*
• Prenatal shunts allow communication btwn. 2 circuits
• MEDICAL EMERGENCY

66
Q

***What is Eisenmenger Syndrome?

A

**• When chronic Left-to-Right shunt is reversed to

become a Right-to-Left shunt

67
Q

***Treatment for Eisenmenger syndrome?

A

Tx: avoid factors that promote ***R-to-L shunt:

strenuous exercise, high altitude, vasodilators

68
Q

VSD
Common?
Initially, _____
Overtime_______ –> (3 dysfunctions) CHS

A

Relatively common defect (~3 per 1000 live births)
- Initially, ↑ blood volume return through lungs to LA
& LV = ↑ SV
• Over time, ↑ volume causes: – Chamber dilation – Systolic dysfunction – HF

69
Q

For what disease do we need prophylaxis? and what?

A

PCN prophylaxis until early adulthood

RHEUMATIC FEVER

70
Q

MITRAL STENOSIS signs are signs of _________ HF signs (JAHDep HC)

A

Right sided HF

JVD
Ascites
Hepatomegaly 
Dependent (peripheral Edema) 
Hoarseness secondary to compression of RECURRENT laryngeal nerve by enlarged pulmonary artery or LA
CXR : KERLEY B lines
71
Q

Disorders with high chance of MVP (MSRTM)

A 
Marfan syndrome
SLE
Rheumatic carditis
Thyrotoxicosis
Myocarditis.
72
Q

Severe Aortic stenosis
Valve area is
Transvalvular pressure gradient is ______
CO is _______With exertion and ______At rest

A

Valve area<0.8cm^2
Transvalvular gradient pressure > 50 mmHg
low with exertion, normal at rest

73
Q

MILD mitral stenosis is associated with

A

Loud S1

74
Q

SEVERE MITRAL STENOSIS is associated with

A

Diminished S1

75
Q

Mild mitral stenosis has a loud ____and an _______occurs in ________ (MLS1 OED)

A

S1; Opening snap occurs in early diastole

76
Q

SEVERE MITRAL STENOSIS has a diminished ______with a __________ @ ____or ____ (SDS1 RMA)

A

Rumbling diastolic murmur at AXILLA or APEX

77
Q

To differentiate aortic stenosis murmur from Mitral regurgitation what do you do?
MRI, ASnot

A

Ask patient to clench fist to INCREASE SVR
in MR murmur will intensify
in AS murmur will NOT

78
Q

MVP occurs in _____-% of the population

A

2-3%

79
Q

MVP is more common in

A

women

80
Q

Symptoms in severe cases’CASIE of MVP

A 
Chest pain
Arrythmia
Sudden cardiac death
Infectious endocarditis 
EMBOLISM
81
Q

MVP is associated with (murmur) ML

A

Midsystolic click

Late systolic murmur

82
Q

What is a Midsystolic Click

A

sudden tensing of leaflet or choardae tendinae when forced back into LA

83
Q

Late systolic Murmur is

A

if regurgitation is present with the prolapse

84
Q

MVP is often

A

benign

85
Q

Normal Aortic Valve area is

A

2-5.-3.5 cm2

86
Q

S4 caused by

A

turbulent flow

87
Q

EKG in AS show

A

LVH

88
Q

For AS, ___%symptomatic patients w/surgery die within

A

75; 3 years

89
Q

Aortic Regurgitation: asymptomatic patients with HTN with preserved LV function benefit (ACCB)

A

Medically from AFTERLOAD REDUCING DRUGS

CCB, Ace

90
Q

NOT imp Pulmonic Regurgitation caused by

valve ring

A

Severe pulmonary HTN

Dilates valve

91
Q

IVDA often involves

A

RIGHT SIDED HEART VALVES

92
Q

Endocarditis best viewed with

A

TEE

93
Q

Acute ABE symptoms (RH)

A

Rapidly progressing illness

High fever and chills

94
Q

Subacute ABE symptoms

A

low grade fever
nonspecific sx , mistaken for INFLUENZA
SBE needs high level of SUSPICION

95
Q

Skin findings of ENDOCARDITIS

VP JORS

A 
VP JORS 
Vasculitis (peripheral stigmata of endocarditis) 
Petechiae
JANEWAY LESIONS
OSLER NODES
ROTH SPOTS
SPLINTER HEMORRHAGES
96
Q

Prevention via prophylaxis ABX in certain conditions (READ)

A 
Presense of prosthetic valve
hx of endocarditis
Hx of congenital HD
Dental procedures
URI
GU GI procedures
Infected ski
97
Q

BP liver is

A

Ductus Venosus

98
Q

BP lungs

A

Foramen Ovale

99
Q

Foramen forced closed when

A

LA pressure become GREATER than RA pressure

100
Q

After birth PGE1 levels

A

decline DA CONSTRICTS CLOSED

101
Q

***A Patent Foramen Ovale with ________can result in _______

A

RIGHT TO LEFT SHUNT

PARADOXICAL EMBOLISM

102
Q

VSD is a common defect with ______per ____LB

A

3 per 1000

103
Q

In VSD, initially

A

Increase blood volume return through lungs to LA and LV = Increase SV

104
Q

Overtime in VSD, increase volume cause (CSH)

A

Chamber dilation
Systolic dysfunction
HF

105
Q

Symptoms of VSD (small)

A

Infants with small VSDs are symptom free

106
Q

***In Mitral stenosis blood back up into______resulting in _________ as evidenced by ________
There is _________pulmonary vascular pressure which could rupture vessels causing ___________

A

Pulmonary veins resulting in pulmonary HTN
AEB- DYSPNEA and ORTHOPNEA
HEMOPTYSIS

107
Q

***In mitral stenosis RV pumps against _________pulmonary vascular pressure leading to _________ which leads to 3 symptoms

A

Increase
Pulmonary HTN
RVH, CHF, RIGHT HF

108
Q

***In mitral stenosis how does it lead to AFIB?

A
  • LA Hypertrophy stretches conduction fibers
  • Disrupts conduction system
  • Leads to Afib, contributes to decrease CO and thrombus formation
109
Q

**In mitral stenosis, what happens to LA

A

Atrial pressure increase

LA hypertrophy

110
Q

**Mitral stenosis and SV and CO

A

There is impaired volume filling

Decreased SV and CO

111
Q

Acute MR

A

Ventricle V shaped

112
Q

***Acute MR : what happens to LA pressure > leads to what?

think ass non compliant

A

Left Atrium relatively NONCOMPLIANT

Acute rise in pressure leads to pulmonary edema

113
Q

***Chronic MR” What hppens to LA

A

LA has time to BECOME COMPLIANT

less pulmonary pressure; pulmonary edema less common

114
Q

***Chronic MR LV is

A

ENLARGED with ECCENTRIC Hypertrophy from chronic VOLUME overload.

115
Q

***LA is dilated in

A

Chronic MR

116
Q

***LV remodeling is ______in chronic MR

A

Eccentric Hypertrophy

117
Q

***ACUTE Aortic Regurgitation (AAR - ANCH)

A
  • Acute in increase in LV diastolic pressure
  • NO TIME TO COMPENSATE
  • CORONARY ISCHEMIA
  • HF
118
Q

***Surgical EMERGENCY requiring IMMEDIATE VALVE REPLACEMENT–> Pulmonary congestion /edema dyspnea

A

ACUTE Aortic REGURGITATION

119
Q

***What happens to LA pressure in acute AORTIC REGURGITATION? what BAD symptoms does it lead to ? PED? Is this an emergency?

A

Increase

PULMONARY CONGESTION, EDEMA, DYSPNEA

120
Q

***ChroniC Aortic Regurgitation (CAR - CRP)

A
  • Causes ADAPTIVE ENLARGEMENT of LA and LV
  • Regurgitation volume is ACCOMODATED with less - DIASTOLIC PRESSURE INCREASE
  • PULMONARY CONGESTION less likely
121
Q

What is meant by Functional tricuspid Regurgitation

A

Malfunctioning tricuspid valve allows backflow of blood into right atrium

SRNAAnatomy II (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions