Cardiac Disorders and 12 Lead EKG Part 2 Flashcards Preview

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Flashcards in Cardiac Disorders and 12 Lead EKG Part 2 Deck (33):
1

Nearly all MIs are coused by thrombotic occlusion of a coronary artery.  True or false?

True

2

What are anesthetic considerations for mitral stenosis to AVOID? (4)

  • tachycardia
  • increases in blood volume (overtransfusion/head down position)
  • decreases in systemic vascular resistance
  • arterial hypoxemia/hypoventilation--this will exacerbate pulmonary HTN

3

What condition is usually due to rheumatic fever and is almost always associated with mitral stenosis?

Mitral regurgitation

4

Mitral Regurgitation

Left atrium volume overload is the principal change caused by a (increase/decrease) in forward left ventricle stroke volume. 

decrease

5

Severe mitral regurgitation occurs when regurgitant fraction > ____%.

60

6

The fraction of the stroke volume that enters the left atrium depends on: (3)

  • size of mitral valve orifice
  • HR
  • pressure gradient across MV

 

7

The following are diagnoses of what following condition?
  • Holosystolic apical murmur
  • Eccentric cardiac hypertrophy/enlargement on PE
  • Echo confirms enlargement of LV chamber
  • color flow doppler revelations

 

Mitral regurgitation

8

What are treatments for mitral regurgitation? (2)

  • early surgical treatment by MV repair
  • MV replacements: attempts made to conserve MV apparatus/LV function to preserve LV contraction

9

Mitral regurgitation anesthetic management: (4)

  • avoid sudden decreases in HR
  • avoid sudden increases in SVR (systemic venous return)
  • minimize drug-induced myocardial depression
  • monitor magnitude of regurgitant flow with echo/pulmonary catheter

10

What condition describes the "billowing of the posterior mitral leaflet into the LA during systole"?

 

Mitral valve prolapse

11

Mitral valve prolapse is associated with: (2)

  • mid-systolic click
  • late systolic murmur

Aka click-murmur syndrome

12

What is the most common form of valvular heart disease in 2.4% of the US population?

Mitral valve prolapse

13

Mitral valve prolapse is not benign and has been associated with cerebral embolic events, infective endocarditis, severe MR, and sudden death.  True or false?

False

It is relatively benign, but the conditions mentioned are true in serious cases.

14

If diagnosis is:

  • redundant and thickened leaflets (anatomic form) 
  • mild bowing and normal appearing leaflets (functional form)

What heart disease does this describe?

Mitral valve prolapse

15

In mitral valve prolapse, redundant and thickened leaflets (anatomic form) will not need endocarditis prophylaxis.  True or false?

False, does need prophylaxis

16

In mitral valve prolapse, mild bowing and normal-appearing leaflets (functional form) does not need endocarditis prophylaxis.  True or false?  

True

17

Anesthetic management for mitral valve prolapse is the same for mitral regurgitation.  True or false?

True

  • Avoid sudden decreases in HR
  • Avoid sudden increases in SVR
  • Minimize drug-induced myocardial depression
  • Monitor magnitude of regurgitant flow

18

Increase LV emptying can accentuate MVP leading to _____ _____ .

mitral regurgitation

19

What can increase LV emptying? (3)

  • increased sympathetic NS activity
  • decreased SVR
  • sitting position

20

An idiopathic disease resulting from degeneration and calcification of aortic leaflets describes what disease?

Aortic stenosis

21

What disease is more likely to occur in persons born with bicuspid aortic valves than with normal tricuspid valves?

aortic stenosis

Note: AS develops earlier (age 30-40) in bicuspid valves than with tricuspid valves (age 60-80)

22

What disease has increased incidence of sudden death?

Aortic stenosis

23

Risk factors for aortic stenosis: (2)

same as ischemic heart disease

  • HTN
  • hypercholesterolemia

24

Aortic stenosis is characterized by obstruction to ejection of blood into the aorta due to decreases in the area of the AV orifice which (decrease/increase) LV pressures to maintain forward SV.  

increase

25

Critical AS when:

  • transvalvular pressure = ____ mmHg 
  • orific area < ___cm2

50

0.8

26

These symptoms commonly describe what heart disease?

  • angina pectoris
  • dyspnea on exertion
  • syncope (associated with exertion)

aortic stenosis

27

Aortic stenosis physical exam diagnosis: detection of a _______.

murmur

More specifically, a systolic ejection murmur that radiates to the neck best heard in the aortic area( 2nd right ICS)

28

Tests to confirm aortic stenosis: (3)

  • CXR: prominent acending aorta is indicated
  • ECG: evidence of left ventricular hypertrophy
  • ECHO: shows thickening and calcification of AV and decreased mobility of valve leaflets

29

Treatment for aortic stenosis: (2)

  • No medical management except for endocarditis, then antibiotic prophylaxis
  • Aortic valve replacement

30

Anesthetic considerations for aortic stenosis: (4)

  • maintain NSR (normal sinus rhythm)
  • avoid bradycardia
  • avoid sudden increases or decreases in SVR
  • optimize intravascular fluid volume to maintain venous return and LV filling

 

31

What results from disease of the aortic leaflets or the aortic root that distorts the leaflets, preventing their coaptation?

aortic regurgitation

 

32

The following causes describe what heart disease?

  • Leaflet abnormalities: infective endocarditis & rheumatic fever
  • Aortic root causes: idiopathic root dilation associated with HTN and aging, thoracic aortic dissection, collagen vascular diseases, and Marfan syndrome

 

Aortic regurgitation

33

The magnitude of aortic regurgitant flow depends on: (2)

  • time available for regurgitation--HR
  • pressure gradient across the AV-SVR