What disease is characterized by a blowing murmur heard best along the left sternal border plus peripheral signs of hyperdynamic circulation (widened pulse pressure,decreased diastolic pressure, and bounding peripheral pulses)?
What tests confirm severity of aortic regurgitation? (3)
CXR & ECG: provides evidence of LV enlargement
Symptoms of aortic regurgitation appear early on. True or false?
appear in advanced stages
Medical therapy of aortic regurgitation is based on decreasing left ventricle afterload by drug induced vasodilation with ______ for acute LV overload and ________ for asymptomatic patients.
Anesthetic considerations for aortic regurgitation: (3)
avoid sudden decreases in HR
avoid sudden increases in SVR
minimize drug-induced myocardial depression
What disease is usually functional, reflecting dilation of the right ventricle due to pulmonary HTN?
What also accompanies tricuspid regurgitation? (2)
RV volume overload due to LV failure produced by aortic or mitral valve disease
What heart disease is secondary to infective endocarditis and also associated with IV drug abuse?
Tricuspid regurgitation is also associated with _____ _____ when valve dysfunction is the result of prior rheumatic fever.
Consequence is RA volume overload is usually well tolerated, but when paired with RV volume overload from LV failure or pulmonary HTN, this can lead to ___ ____ failure which can cause ___ atrium pressure to be greater than ___ atrium pressure resulting in left-to-right intracardiac shunt through an incompletely closed foramen ovale.
Anesthetic consideration for tricuspid regurgitation: (5)
maintain IV volume
maintain central venous pressures in high normal ranges to facilitate adequate RV stroke volume and left ventricular filling
avoid events that increase PVR (arterial hypoxemia and hypercarbia)
consider Ketamine since no vasodilation occurs
avoid IV infusion of air due to possibility of right-to-left intracardiac shunt through an incompletely closed foramen ovale
What condition is this?
BP > 140/90 on at least 2 occasions measured at least 1-2 weeks apart
The following conditions can develop as a result of ____ ______.
- ischemic heart disease
- congestive heart failure
- cerebral vascular accident
- arterial aneurysm
- end stage renal disease
Optimal BP is: ____/_____
Normal BP is less than ____/____
High-normal BP ranges from:
Systolic: ___ - _____
Diastolic: ____ - _____
Stage 1 Hypertension ranges from:
140 - 159
Stage 2 Hypertension ranges from:
160 - 179
100 - 109
Stage 3 Hypertension BP is ___ / ___
What accounts for 95% of all cases of HTN?
The cause of ____ HTN cannot be identified.
Familiar incidence and patholphysiological factors such as:
- increased sympathetic NS activity
- overproduction of Na retaining hormones & vasoconstrictors
- high Na intake
- increased renin secretion
- deficiencies of vasodilators
describe ______ hypertension.
Known etilogy is present in _____ HTN.
What is the most common secondary type of HTN?
Renovascular HTN from renal artery stenosis
When renovascular HTN is present, diastolic BP is usually > ____ mmHg and an ____ ____ ___ is present.
upper abdominal bruit
What test confirms secondary HTN?
What is the treatment of essential HTN?
lifestyle modification: weight reduction, increase in physical activity, moderation in alcohol, quit smoking
pharmacologic therapy: diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers
calcium channel blockers
Secondary HTN is treated by: (2)
treatment is often surgical (angioplasty, surgery for stenotic renal artery, adrenalectomy)
pharmacologic therapy reserved for patients in those where surgery is not possible
Hypertensive crisis when acute diastolic BP > _____mmHg.
Need for emergent treatment determined by absolute BP rather than rate of increase. True or false?
determined by rate of increase rather than absolute BP
Patients with evidence of acute or ongoing target organ damage (encephalopathy, CHF, renal insufficiency, subarachnoid hemmorage) require prompt treatment with ____ BP lowering agents.
Don't decrease BP to normotensive levels!
Desired decrease is MAP < ___% in first 2 hours, then additional decreases over next ___-___ hours.
Meds to consider delivering during hypertensive crisis: (3)
Anesthetic considerations for HTN during preop evaluation: (3)
determine adequacy of BP control
review drugs being administered for BP control
evaluate evidence of end-organ damage
For HTN patients: induction of anesthesia considerations: (2)
anticipate exaggerated BP changes
limit duration of DL
For HTN patients: maintenance of anesthesia considerations: (2)
administer a volatile anesthetic to blunt HTN responses
monitor for MI
For HTN patients: post-op management considerations (2)
anticipate periods of HTN
maintain monitoring of end-organ function
Condition occurs when the heart is unable to provide sufficient pump action to distribute blood flow to perfuse tissues and organs of the body.
Congestive heart failure
What are the causes of CHF? (4)
impaired contractility secondary to ischemic heart disease or cardiomyopathy
pulmonary HTN (cor pulmonale)
What is the most common form of heart failure?
Fluid may back up in the lungs causing SOB.
left-sided heart failure
What most commonly results from left-sided heart-failure?
right-sided heart failure
Fluid may back up into the abdomen (ascites) and legs and feet (edema) in this type of heart failure.
right-sided heart failure
In this type of heart failure, the left ventricle cannot contract vigorously, indicating a pumping problem.
EF < ___% in this case.
In this type of heart failure, the left bentricle cannot relax or fill fully, indicating a filling problem from noncompliant ventricles.
diastolic heart failure