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Cardiology - Dr Constable > Quiz 6 Valvular Heart Disease > Flashcards

Quiz 6 Valvular Heart Disease Flashcards

(51 cards)

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1
Q

At what levels can Aortic Stenosis occur?

A

Valvular
SubValvular
Supravalvular

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2
Q

What kinds of valvular stenosis can occur?

A
  1. Calcification & fibrosis of normal aortic valve (very common)
  2. Calcification & Fibrosis of congenital bicuspid AV (Higher incidence of stenosis ~ 40yrs old)
  3. Rheumatic - Uncommon since antibiotics
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3
Q

What is the normal aortic valve area?

A

2-4 cm2

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4
Q

In Severe aortic stenosis, what might the valve area be?

A

< 1 cm2

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5
Q

What is the normal LV mean peak gradient?

A

> 50 mmHg

** In severe AS, PG can be very low

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6
Q

What two factors can be used to judge the degree of stenosis?

A

Pressure

Valve area

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7
Q

Increased Pressure will lead to concentric or eccentric LVH?

A

Concentric

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8
Q

Increased Volume will lead to concentric or eccentric LVH?

A

Eccentric

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9
Q

Why is keeping a pt in SR so important for a pt with severe Aortic Stenosis?

A

SR is crucial to keep atrial kick. Atrial kick contributes up to 20% of ventricular filling in a normal heart and up to 40% in an ailing heart. Avoid A-fib and cardiovert early for acute changes

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10
Q

Should you try and keep a pt with AS slightly tachycardic?

A

No. Optimal HR is 60-80.

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11
Q

Why is tachycardia/Bradycardia bad for pts with stenotic lesions?

A

Tachy - decreased diastolic filling time leads to ischemia

Brady - leads to low CO due to fixed stroke volume

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12
Q

How should you treat hypotension for a pt with AS, Phenylephrine or Ephedrine?

A

Phenylephrine - alpha agonist effect will cause vasoconstriction, increase SVR and BP. Ephedrine would not be best due to beta 1 effects (increased HR).
**Can also use Norepi

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13
Q

Can placing a pt with AS in Trendelenburg be beneficial if pt is hypotensive?

A

yes. Can raise BP by 20 mmHg

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14
Q

A pt with AS has low preload and tachycardic. Should they get a spinal or epidural for the their case?

A

Neither - can cause vasodilation of Lower extremities and decrease SVR and BP.

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15
Q

Should you avoid benzos in management of AS?

A

No. for frail or elderly, can give smaller dose or none at all

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16
Q

When you are taking a pt with AS back to the OR, is it best to have an Arterial line pre-induction or can you wait until post-induction?

A

Pre-induction is best

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17
Q

Besides an Arterial line for a pt with AS, what other monitoring equip should this pt have?

A

CVP, PAC, TEE

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18
Q

Why is Systolic Anterior Motion with LVH a concern?

A

If LV is underfilled, MV can come down and touch septal wall of hypertrophied LV - obstructing outflow

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19
Q

How do you treat a pt with LVH and SAM?

A

Fluid Volume and Beta Blockers

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20
Q

A pt with acute Aortic regurgitation, will they have dilated LV?

A

No. will lead to increased LVEDP + LVEDV –> acute pulmonary edema

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21
Q

A pt with acute aortic regurg, could this be emergent?

Study These Flashcards
A

yes and surgery is often required.

** Treat with inotrope and vasodilator (Epi + nipride or milrinone)

22
Q

What is the 4 “F’s” for a regurgitant lesion?

Study These Flashcards
A

Fast, Forward and Full

Just kidding, there’s only 3 F’s.

23
Q

What heart rate is optimal for aortic regurg?

Study These Flashcards
A

slightly tachy - 90 bpm

24
Q

What medication is preferred for treating high afterload in a pt with AR?

Study These Flashcards
A

Sodium nitroprusside

25
Should an intra aortic balloon pump be used in a pt with Aortic Regurg?
No, contraindicated
26
What medications would be beneficial for RSI in a pt with acute aortic regurg?
Ketamine and Succ
27
What are the Triad of Symptoms related to Aortic Stenosis and life expectancy?
Angina - 5yrs from onset Syncope - 3-4 yrs CHF - 1-2 yrs
28
What is the most common congenital reason for Aortic Stenosis?
Bicuspid aortic valve
29
What is the most common acquired reason for aortic stenosis?
senile followed by rheumatic
30
What is the most common cause of Mitral Stenosis?
Rheumatic heart disease
31
What are some of the signs of MS?
Fatigue, CP, palp, SOB, paroxysmal nocturnal dyspnea, pulm edema, hemoptysis, hoarseness due to compression of RLN by distended left atrium and enlarged pulm artery
32
When would you consider doing surgery on a pt with MS?
When their mitral valve area is < 1 cm2 with NYHA class III or IV dyspnea
33
With all stenosis, what are 2 things you would want to maintain?
Sinus rhythm and normal HR (60-80)
34
What are some things you would want to avoid in a pt with MS?
``` Hypercarbia Acidosis Hypothermia SNS activation Hypoxia ```
35
If a pt has pulm HTN, what could you do to do?
Start supplemental oxygen
36
How could you control the HR for a pt with MS?
B-blockers, Dig, Ca-Channel blockers, amiodarone
37
What is the single most useful drug to use on pts with severe MS?
Esmolol 10-20mg bolus, 50-100 mcg/kg/min | **even with CHF and Pulm Edema
38
What anesthetic gas should be avoided on a pt with Pulm HTN?
N2O
39
What NDMR should be avoided on the pt with MS?
Pancuronium - can cause tachycardia
40
Why would a pt with Mitral regurg be more likely to have atrial arrhythmias?
Due to dilated LA. LA can be massively dilated
41
Volume overload in a pt with mitral regurg can lead to __________ and ___________ enlargement
LV and LA
42
What 3 factors can determine the severity of Mitral Regurg?
Pressure gradient against LA and LV Size of regurgitant orifice Duration of ventricular systole
43
Why would you want to use vasodilators like NTG or nitroprusside for regurgitant lesions?
Helps decrease SVR and keeps forward flow of blood
44
What can be unmasked after repair of MR?
LV dysfunction may have been masked by its decreased ability to offload into the LA
45
What is a primary reason for Tricuspid regurg?
rheumatic, inf endocarditis, carcinoid, Epstein Bar, trauma
46
In a pt with Tricuspid regurg and R heart failure, what other problems may be manifested?
hepatomegaly | Ascites
47
Be sure to look through slides at the anesthetic management and weaning from CPB
yeah
48
What is the most common cause of Mitral Regurg?
Myxomatous degeneration: breakdown of the valve
49
What things determine the severity of mitral Regurg?
- pressure gradient between LA + LV - size of regurgitant orifice - duration of ventricular systole
50
What should you avoid with tricuspid Regurg?
Pulm htn and high PVR
51
For tricuspid Regurg, how do you want the preload, high or low?
Normal to high preload | ** treat hypotension with inotropes and volume (vasoconstrictors may worsen pulm htn)

Cardiology - Dr Constable (9 decks)

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