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Summer 2020 - Advanced Anesthesia - CV > Anesthesia for Valvular Heart Disease - Quiz 5 > Flashcards

Anesthesia for Valvular Heart Disease - Quiz 5 Flashcards

1
Q

What causes Aortic Stenosis?

A

Calcification & Fibrosis of a Normal Aortic Valve or a Congenital Bicuspid Aortic Valve

&

Rheumatic Disease

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2
Q

What is the Normal Aortic Valve Area?

A

2 - 4 cm2

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3
Q

At what Aortic Valve Area would indicate surgical intervention?

A

< 1 cm2

(Severe Aortic Stenosis)

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4
Q

What is the Mean Pressure Gradient for a Normal Left Ventricle?

A

> 50 mmHg

Poor LV Function = Low Mean Pressure Gradient

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5
Q

What happens to the Left Ventricle w/ Aortic Stenosis?

A

Concentric LV Hypertrophy to ↓Wall Stress

↓Diastolic Compliance & Coronary Blood Flow

O2 Supply/Demand Mismatch

↑LVEDP & LVEDV

Myocardial Ischemia

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6
Q

What are the Hemodynamic Goals for Aortic Stenosis?

A

Maintain Preload, Contractility, and NSR for Atrial Kick

Maintain CPP w/ Neosynephrine or Norepi

Avoid Myocardial Depressants & Hypotension

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7
Q

What type of Anesthesia is Contraindicated for a pt w/ Severe Aortic Stenosis?

A

Spinal & Epidural

Poorly tolerated if pt has ↓Preload or ↑HR

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8
Q

In addition to standard monitoring, what else should be included for pts w/ Severe Aortic Stenosis?

A

A-Line

CVP

PAC

TEE

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9
Q

What is a problem that occurs for a pt w/ aortic stenosis when Weaning from Bypass?

A

Stiff Stone Heart w/ subaortic or cavitary obstruction

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10
Q

How should stone heart be treated?

A
  • Volume
  • Inotropes (can worsen obstruction)
  • B-Blockers
  • Myomectomy (Rare)
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11
Q

What causes Aortic Regurgitation?

A

Aortic Root Dilation

Abnormal Cusps

Cusp Prolapse

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12
Q

What are causes of Aortic Root Dilation?

A

HTN

Ascending Aorta Dissection

Cystic Medial Necrosis

Marfans

Syphilitic Aortitis

Ankylosing Spondylitis

Osteogenesis Imperfecta

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13
Q

What happens to the LV with Chronic Aortic Regurgitation?

A

LV Volume & Pressure Overload

Eccentric Hypertrophy - thins out & dilates to ↑compliance

↑LVEDP & LVEDV

CHF, Arrythmias, Death

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14
Q

What are the Hemodynamic Goals for Aortic Regurgitation?

A

Avoid Bradycardia & High Afterload

HR = 90

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15
Q

What meds are used for Aortic Regurgitation?

A

Nitroprusside

Epinephrine

Milrinone

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16
Q

Why are Intra-Aortic Balloon Pumps contraindicated for Aortic Regurgitation?

A

IABP will increase Regurgitant Volume

17
Q

What causes Mitral Stenosis?

A

Rheumatic Disease

Fusion of MV Leaflets

Comissures

Calcifications & Thickening of MV

18
Q

When is surgery indicated for a pt w/ Mitral Stenosis?

A

MVA < 1 cm2

&

Presence of LA Clot

19
Q

What problems are associated w/ Mitral Stenosis?

A

Inadequate LV Filling

Pulm. HTN

Atrial Arrythmias

RV Dysfunction

20
Q

What are the Hemodynamic Goals w/ Mitral Stenosis?

A

Maintain NSR

Avoid Tachycardia

Avoid Worsening Pulm. HTN

21
Q

What are factors that worsen Pulm. HTN?

A

Hypercarbia

Acidosis

Hypothermia

Sympathetic Activation

Hypoxia

22
Q

Which med is the most useful drug in managing pts w/ severe Mitral Stenosis?

A

Esmolol - fast on and fast off

10-20 mg bolus

50-100 mcg/kg/min

23
Q

Which med should be avoided in pts w/ Mitral Stenosis?

A

N2O - worsens Pulm HTN

24
Q

What causes Mitral Regurgitation?

A
  • Myxomatous Degeneration - most common
  • CAD/Ischemia - Papillary & LV Dysfunction, Annular Dilation, Tethering
  • Endocarditis
  • Trauma
25
Q

What are the Hemodynamic Goals w/ Mitral Regurgitation?

A

Fast Full Foward

High/Normal HR

Maintain Contractility

↓Afterload (NTG, SNP)

26
Q

In Mitral Regurgitation, will the LV ejection fraction increase or decrease after Mitral Valve Repair?

A

EF will Decrease - LV no longer has two outlets (LA & Aorta)

27
Q

What causes Triscuspid Regurgitation?

A

Rheumatic Disease

Endocarditis

Ebstein’s

Trauma

RV Dilation

28
Q

What is the Pathophysiology of Tricuspid Regurgitation?

A

Dilated RA

RV Overload

Pulm. HTN

Right Heart Failure

Hepatomegaly & Ascites

29
Q

What are the Hemodynamic Goals w/ Tricuspid Regurgitation?

A

Avoid Pulm. HTN & PVR

Normal/High Preload

Avoid Hypotension w/ Inotropes & Volume

Summer 2020 - Advanced Anesthesia - CV (9 decks)

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