Nearly all MIs are coused by thrombotic occlusion of a coronary artery. True or false?
What are anesthetic considerations for mitral stenosis to AVOID? (4)
increases in blood volume (overtransfusion/head down position)
decreases in systemic vascular resistance
arterial hypoxemia/hypoventilation--this will exacerbate pulmonary HTN
What condition is usually due to rheumatic fever and is almost always associated with mitral stenosis?
Left atrium volume overload is the principal change caused by a (increase/decrease) in forward left ventricle stroke volume.
Severe mitral regurgitation occurs when regurgitant fraction > ____%.
The fraction of the stroke volume that enters the left atrium depends on: (3)
size of mitral valve orifice
pressure gradient across MV
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
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
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
What condition describes the "billowing of the posterior mitral leaflet into the LA during systole"?
Mitral valve prolapse
Mitral valve prolapse is associated with: (2)
late systolic murmur
Aka click-murmur syndrome
What is the most common form of valvular heart disease in 2.4% of the US population?
Mitral valve prolapse
Mitral valve prolapse is not benign and has been associated with cerebral embolic events, infective endocarditis, severe MR, and sudden death. True or false?
It is relatively benign, but the conditions mentioned are true in serious cases.
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
In mitral valve prolapse, redundant and thickened leaflets (anatomic form) will not need endocarditis prophylaxis. True or false?
False, does need prophylaxis
In mitral valve prolapse, mild bowing and normal-appearing leaflets (functional form) does not need endocarditis prophylaxis. True or false?
Anesthetic management for mitral valve prolapse is the same for mitral regurgitation. True or false?
- Avoid sudden decreases in HR
- Avoid sudden increases in SVR
- Minimize drug-induced myocardial depression
- Monitor magnitude of regurgitant flow
Increase LV emptying can accentuate MVP leading to _____ _____ .
What can increase LV emptying? (3)
increased sympathetic NS activity
An idiopathic disease resulting from degeneration and calcification of aortic leaflets describes what disease?
What disease is more likely to occur in persons born with bicuspid aortic valves than with normal tricuspid valves?
Note: AS develops earlier (age 30-40) in bicuspid valves than with tricuspid valves (age 60-80)
What disease has increased incidence of sudden death?
Risk factors for aortic stenosis: (2)
same as ischemic heart disease
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.
Critical AS when:
- transvalvular pressure = ____ mmHg
- orific area < ___cm2
These symptoms commonly describe what heart disease?
- angina pectoris
- dyspnea on exertion
- syncope (associated with exertion)
Aortic stenosis physical exam diagnosis: detection of a _______.
More specifically, a systolic ejection murmur that radiates to the neck best heard in the aortic area( 2nd right ICS)
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
Treatment for aortic stenosis: (2)
No medical management except for endocarditis, then antibiotic prophylaxis
Aortic valve replacement
Anesthetic considerations for aortic stenosis: (4)
maintain NSR (normal sinus rhythm)
avoid sudden increases or decreases in SVR
optimize intravascular fluid volume to maintain venous return and LV filling
What results from disease of the aortic leaflets or the aortic root that distorts the leaflets, preventing their coaptation?
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
The magnitude of aortic regurgitant flow depends on: (2)