Cardiac Surgery 2

Question 1

what are two hemodynamic goals for patients with stenotic lesions?

Answer 1

avoid increased HR

avoid decreased SVR

Question 2

what is the area for the mitral valve, and aortic valve?

Answer 2

mitral valve is 4-6 cm squared

aortic valve is 2.5-3.5 cm squared

Question 3

what is the stenotic area and pressure gradient for the mitral valve?

Answer 3

area of < 1 cm squared

pressure gradient of > 10 mmHg

Question 4

what is the stenotic area and pressure gradient for the aortic valve?

Answer 4

area of < 0.75 cm squared

pressure gradient of > 50 mmHg

Question 5

what kind of murmur would you hear for mitral stenosis?

Answer 5

a rumbling diastolic murmur

Question 6

what two main problems present from mitral stenosis?

Answer 6

right ventricular hypertrophy

pulmonary edema

Question 7

what is mitral stenosis most commonly caused by?

Answer 7

rheumatic fever

Question 8

why should careful consideration be used in patients with mitral stenosis?

Answer 8

they have a fixed CO, and may not be able to compensate for vasodilation

epidural is preferred

Question 9

what arrhythmia typically forms in patients with mitral stenosis, and why?

Answer 9

atrial fibrillation, because increased LA pressure leads to stretching of the pathways

Question 10

what drug is good for rate control in patients with atrial fibrillation?

Answer 10

digoxin

Question 11

in patients with aortic stenosis, why must aortic diastolic pressure be maintained?

Answer 11

because aortic diastolic hypotension leads to decreased coronary perfusion

Question 12

what are the three main causes of aortic stenosis?

Answer 12

calcification of the valve

congenital bicuspid aortic valve

rheumatic fever

Question 13

what is the classic triad of symptoms in aortic stenosis?

Answer 13

angina
congestive heart failure
syncope

Question 14

what is the survival rate for aortic stenosis patients with angina, CHF and syncope?

Answer 14

angina is 5 years
CHF is 3 years
syncope is 1 year

Question 15

how long is the latent period before aortic stenosis symptoms appear?

Answer 15

30 years

Question 16

why is it so important to maintain sinus rhythm in patients with aortic stenosis?

Answer 16

atrial kick is important for ventricular filling, as ventricular compliance decreases

Question 17

in patients with severe LV dysfunction a PA catheter may be used, why would PCWB underestimate LA pressure?

Answer 17

because due to overfilling there is decreased LV compliance

Question 18

is nitrous oxide okay in patients with aortic stenosis?

Answer 18

yes

Question 19

what murmur would you hear for mitral regurgitation?

Answer 19

holosystolic murmur at lower left sternal border

Question 20

what murmur would you hear for aortic regurgitation?

Answer 20

decrescendo diastolic murmur

Question 21

what is acute mitral regurgitation?

Answer 21

LA and LV are not enlarged

LVEDP and LAP are elevated

patient is in NSR

Question 22

what is chronic mitral regurgitation?

Answer 22

LA and LV are enlarged

LVEDP and LAP are high, but not as high as acute condition

a-fib is common

Question 23

what are three signs of right heart failure?

Answer 23

hepatic congestion
peripheral edema
JVD

Question 24

how is mitral regurgitation medically treated?

Answer 24

digoxin
decrease SVR
SBE prophylaxis

Question 25

what three things should be considered preoperatively for patients with mitral regurgitation?

Answer 25

treat a-fib avoid increased PVR SBE prophylaxis

Question 26

what two methods decrease regurgitation fraction in patients with mitral regurgitation?

Answer 26

small increase in HR, as increased diastolic time worsens regurgitation decrease SVR

Question 27

what three words do you remember for anesthetic goals in patients with mitral regurgitation?

Answer 27

full fast vasodilated

Question 28

what kind of murmur would you hear with aortic regurgitation?

Answer 28

diastolic murmur at left upper sternal boarder?

Question 29

does aortic regurgitation cause concentric or eccentric hypertrophy?

Answer 29

eccentric hypertrophy

Question 30

what are two main hemodynamic goals for patients with aortic stenosis?

Answer 30

small increase in HR decrease SVR

Question 31

what is the most common etiology of congestive heart failure?

Answer 31

coronary artery disease

Question 32

what are three classic symptoms of CHF?

Answer 32

dyspnea fatigue pulmonary congestion

Question 33

patients with compensated CHF have no physical symptoms, but what symptoms would uncompensated patients have?

Answer 33

pulmonary rales pulmonary edema JVD ascites and hepatomegaly

Question 34

should beta blockers be used in patients with acute or chronic CHF?

Answer 34

chronic, beta blockade can worsen acute heart failure

Question 35

what EF is associated with increased operative risk?

Answer 35

< 40%

Question 36

what are three intraoperative hemodynamic goals for patients with CHF?

Answer 36

maintain inotropy reduce afterload normalize PVR