Cardiac Flashcards
(91 cards)
1
Q
Valvular Symptoms?
NAPPED-OF
A
- Neurologocal Symptoms
- Angina
- Pedal Edema
- Paroxysmal Nocturnal Dyspnea
- Exercise Tolerance (MET’s)
- Dyspnea
- Orthopnea
- Fatigability
2
Q
Left sided valve disorders idenfified by what sounds?
A
- Pulmonary Rales (fine crackles)
- S3 Gallop
3
Q
Right sided valve disorders idenfified by what?
A
- Jugular Vein distension
- Pedal Edema
4
Q
Advanced methods to diagnose valvular disease?
A
- TEE
- TTE
- Right heart cath
5
Q
Blood Flow Path in Heart
A
- IVC/SVC
- RA
- Tricuspid valve
- RV
- Pulmoary valve
- Pulmonary Artery
- LA
- Mitrial Valve
- LV Aorta
- Aortic Valve
6
Q
What is vena contracta?
A
The point in a fluid stream where the diameter of the stream is the least, and the fluid velocity is at its max
7
Q
What is EROA?
A
Effective Regurgitant Orifice Area
8
Q
What is PISA?
A
Proximal Isovelocity Surface Area
9
Q
What is the basic summation of EROA?
A
The overall area of regurg
10
Q
Annulus
A
Fibrous ring of tissue that can accommodate to the dynamic aspects of the myocardium and the valve leaflets
11
Q
Tricuspid Valve Values
Normal
A
- Valve Area: 4-6 cm^2
- Annular Diameter: 23-33 mm
12
Q
Tricuspid Valve Values
Regurg
A
Annular Diameter: >40 mm
Regurg Flow: >30%
Vena Contracta: ≥ 7 mm
EROA: ≥40 mm^2
13
Q
Tricuspid Valve Values
Stenosis
A
- Valve Area: < 1cm^2
- Mean Gradient: 5-10 mmHg @ 70 bpm
14
Q
Pulmary Valve Values
Normal
A
Valve Area: 2.5 - 4.0 cm^2
15
Q
Pulmonary Valve Values
Regurg
A
- Regurg volume: 30-59 mL
- Regurg fraction: 30-49%
Moderate
16
Q
Pulmonary Valve Values
Stenosis
A
Mean Gradient: 30-60 mmHg
Moderate
17
Q
Mitral Valve Values
Normal
A
Valve Area: 4-6 cm^2
18
Q
Mitral Valve Values
Regurg
A
Regurg volume: 30-59 mL
Regurg fraction: 30-49%
Vena Contracta: 0.3-0.69 cm
EROA: 0.2-0.39 cm^2
Moderate
19
Q
Mitral Valve Values
Stenotic
A
Valve Area: 1.0-2.5 cm^2
Mean gradient: 6-10 mmHg
Moderate
20
Q
Aortic Valve Values
Normal
A
Valve Area: >2.0 cm^2
21
Q
Aortic Valve Values
Regurg
A
Regurg Volume: 30-49 mL
Regurg Fraction: 30-49%
Vena Contracta: 0.3-0.6 cm
EROA: 0.1-0.29 cm^2
Moderate
22
Q
Aortic Valve Values
Stenotic
A
Valve Area: 1.0-1.5 cm^2
Mean gradient: 25-40 mmHg
23
Q
Best heart rates for regurg?
A
Faster heart rates limit the time for backflow
24
Q
Stenotic valves best heart rate?
A
Slower rates increase flow across the stenoic valve
25
Tricuspid Stenosis
Uncommon and associated with RHD
26
Tricuspid Stenosis managment
High Preload
Adequate contractablity
27
Right Atrial Dilation symptoms
| J-PACHA
* Jugular vein distension
* Peripheral Edema
* Ascities
* Can induce arrythmias
* Hepatomegaly
* Anasarca
## Footnote
Anasarca is systemic edema
28
Tricuspid Regurg primary causes
Endocarditis
Carcinoid Syndrome
Ebstein Anomoly
29
Tricuspid regurg secondary causes
RV Dilation
Severe PHTN
30
Tricuspid Regurg Symptoms
Fatigue
Edema
Ascities
31
Tricuspid Regurg Treatments
Volume/Salt reduction
Diuretics
Reduce PHTN if present
## Footnote
Endothelin Receptor Antagonists: "sentan's"
Phosphodiesterase Inhibitors: Viagra/Cialis "fil"
32
Manage PHTN
NO
sentan's
fil's
33
Manage RHF
Milrinone
Dobutamine
34
Managing Tricuspid Regurg
Maintain volume
Heart rate: normal to elevated
35
Tricuspid Regurg and neuraxial techniques
Controversial
* if RHF present then a decrease in coronary perfusion pressure could be bad
36
Pulmonic stenosis is most common in which demographic?
Pedi's
37
Pulmonic stenosis does what?
## Footnote
2
1. RV remodeling to compensate
2. Usually asymptomatic until severe levels of stenosis present
38
Pulmonic stenosis management
* Preserve RV preload
* Preserve RV contractability
* Avoid increased PVR
39
Pulmonic Regurg Primary Causes
Endocarditis
Carcinoid Syndrome
Iatrogenic
40
Pulmonic Regurg Secondary Cause
Pulmonary Artery dilation
41
Pulmonic Regurg Management
Reduce PHTN if present
Maintain RV function
42
Mitral Stenosis mostly due to what?
Rheumatic fever
43
Mitral Stenosis
* Mild to moderate
Minimally increased left atrial volume / pressure
Increase in HR can casue symptoms
44
Mitral Stenosis
* Severe
Increased LA pressure / volume
Symptoms at rest
45
Mitral Stenosis
* Symptoms by stressor
## Footnote
PEFS
* Pregnancy
* Emotional Stress
* Fever
* Sepsis
46
Mitral Stenosis
* Main Symptoms
## Footnote
PROTEA
* Pulmonary Hypertension
* RHF
* Ortner Syndrome
* Thromboembolism risk
* Exertional Dyspnea
* Afib
## Footnote
Ortner: LA compression on Recurrent Laryngeal Nerve (RLN)
47
Why is mitral stenosis a thrmboembolis risk?
LA appendage
48
Mitral Stenosis Physical Exam
## Footnote
P-PICA
* Pulmoary Rales
* Peripheral Edema
* Increased Jugular Venous Pressure
* Cutaneous Vasodilation
* Ascities
49
What are Mitral Facies?
## Footnote
A type of cutaneous vasodilation
Pink-purple patches on cheeks
* Sign of Mitrial Stenosis
50
What three types of remodeling does mitral stenosis cause?
1. LA hypertrophy
2. R Heart changes
3. Intersitial Fibrosis
51
HR for Mitral stenosis and which drug?
Slow it down for more filling time with BB
52
Mitral Stensos and anticoag?
Yes is Afib present
Epidural > Spinal
53
Mitral Stenosis and CO
prevent and treat any decrease in CO
54
Avoid what in Mitral Stenosis?
## Footnote
KISS
Ketamine for induction
Increased PVR
Suddent drops in SVR
Signs of any new Afib or tachyarrhythmias
55
Mitral Regurg
* Acute
## Footnote
2 things
Papillary muscle ischemia or infarction
Papillary muscle rupture
56
Mitral Regurg
* Chronic
## Footnote
ACME
* Annular dilation
* Chordae incompetance
* Myxoma
* Endocarditis
## Footnote
Myoxma: Begnin growth in atria on a stalk that sways in the blood flow getting trapped in the valve not letting it close properly
57
Why does Mitral regurg cause dereased CO?
Part of LV contraction is squeezed back in the LA
58
Mitral Regurg: As the blood backs up, what happend?
LV Hypertrophy
LHF
Pulmoary edema
RHF
## Footnote
If RHF occurs then we have bi-ventricular failure = death
59
Mitral regurg is asymptomatic until when?
LV enlargement
New onset pulmonary HTN
New onset Afib
60
Mitral regug symptoms
DOE
Fatigue
61
What two things can cause a mitral valve prolapse
1. leaflet tenting into LA
2. connective tissue disorder
62
What is the most common precursor to Mitral valve regurg?
Mitral Valve prolapse
63
Mitral Regurg Anesthestic goals
## Footnote
FULL-FAST-FORWARD
Keep Euvolemic (Full)
Normal to elevated HR (Fast)
Maintain contractability (Forward)
Also: Reduce afterload (Forward) with neuraxial techniques
64
What drugs are given to help with LV dysfuntion and Mitral regurg?
## Footnote
2
Vasodilators
Inotropes
65
What do we avoid in Mitral Regurg?
* Sympathetic responses (acute rises in SVR)
* Increases in PVR
1. Hypercarbia
2. Hypoxia
66
Aortic Stenosis
* High Association with?
## Footnote
HARSH-DM
* HTN
* Atherosclerosis
* Rheumatic Fever
* Smoking
* Hypercholesterolemia
* Diabetes
* Males
67
Who will eventually get aortic stenosis?
Everyone who live long enough
68
Bicuspid Aortic Valve
common cause of aortic stenosis
69
Aortic Stenosis: What does limiting flow cause in the heart?
## Footnote
HAIL-LVH
* Higher LV pressures to maintaine SV
* Angina without CAD
* Increased O2 demand with decreased O2 supply
* Limited cardiac reserve
LVH: Left ventricualr hypertrophy caused by increased pressures will eventually fail to compensate for the the reduction in CO = heart failure
70
Aortic Stenosis Symptoms
AS Triad
Once symptoms arise survival decline
## Footnote
These symptoms occure later in the disease progresson state
71
Aortic Stenois triad
## Footnote
SAD
1. Syncope
2. Angina
3. DOE
72
Aortic Stenosis Anesthesia Goals
Maintain preload
Normal HR
No excess chronotropics
73
Aortic Stenosis: Avoid what in mangement
Hypotension
Abrupt reduciton in SVR
## Footnote
Regional not advised
74
Aortic Regurg caused by what three things
## Footnote
BOA
Bicuspid abnormality
Obstruction
Annular Dilation
75
What types of obstruction can cause Aoritc regurg
## Footnote
3
1. Calcification
2. Myxoma
3. Endocarditis
76
What three things can cause annular dilation in aortic regurg?
1. Aortic root
2. LVOT
3. Connective tissue disorder
77
What does aortic regurg do to the heart?
## Footnote
3
Increased LV end-diastolic volume / pressure
Acute: Ischemia
Chronoic: LV Hypertrophy to compensate
78
Aortic regurg symptoms
## Footnote
RABID-HD
* Reduction in diastolic pressure
* Angina
* Bradycardia
* Increased regurg volume
* DOE
* Heart Failure
* Decreaed CPP
79
Aortic regurg treatment
Decrease SVR
Diuretics
Surgical intervention
80
Aortic regurg anestetic goals
## Footnote
FULL-FAST-FORWARD
Forward LV SV
Reduce SVR with vasodilators
Inotropes
Blunt symptheitc responses with narcs (but avoid bradycardia)
81
Avoid what in aortic regurg
High dose volatile agent
Fast wake up (abrupt causes increase in SVR)
82
Infective Endocarditis
Bacterial infection usually on heart valves
## Footnote
Dental procedures, Respiratory infections, skin infections, and toal joint infections
83
Infective Endocardidtis usually presents as?
Regurg valve
84
HOCM
Hypertrophic Obstructive Cardiomyopathy
85
HOCM signs and symptoms
| P-DITCH
Palpitaions
DOE
Initial signs can be DEATH
Tachydysrythmias
Chest Pain
Heart Failure
86
HOCM mimics what?
Mitral regurg and Aortic stenosis
87
HOCM PeriOp Management Drugs
* BB
* CCB
* Volatile Agents
88
HOCM PeriOp Management
Regional can be used
Prompt fluid replacement
89
HOCM Contraindicated Meds
Ephedrine
Dopamine
Dobutamine
90
Heart Transplant concerns
Immunosupressed
De-innervated Heart
2 P waves
No vagal tone
Delayed response to Hypotension/Hypovelimia
91
Heart Transplant Abx
Cyclosporine: causes hyptertension and nephrotoxic
Tacrolimus: nephrotoxic
