Valve Disease

Question 1

h&p valve disease assess 4 things

Answer 1

Severity of disease, degree of contractility impairment, assoc major organ disease, development of compensatory mechanisms to maintain CO (inc sns, cardiac hypertrophy)

Question 2

Exercise tolerance evaluates what

Answer 2

Cardiac reserve

Question 3

CHF manifests as 3 signs, companion of what

Answer 3

Dyspnea, orthopnea, fatigue. Chronic valvular heart disease

Question 4

Compensatory inc SNS manifested by which signs

Answer 4

Anxiety, diaphoresis, resting tachycardia.

Question 5

Common specific cardiac signs of valvular heart disease

Answer 5

Dysrhythmias (afib), angina (inc muscle mass w/not enough 02 delivery)

Question 6

Drug tx: 3 most common

Answer 6

Dig, diuretics, abx prophylaxis

Question 7

Digitalis indication

Answer 7

Inc contractility, decrease hr response w afib

Question 8

Diuretic: indication but may result in

Answer 8

Tx extra fluid vol but could result in hypokalemia and dig toxicity

Question 9

Lab data: 3

Answer 9

Doppler echo, cardiac cath to measure VHD severity, arterial bg dec pao2 and v-q mismatch

Question 10

Mitral stenosis: patho, size, pressure gradient to maintain CO

Answer 10

Fusion of MV leaflets at commissaries during healing of rheumatic fever. <1 cm, 25 mmhg

Question 11

Mitral stenosis: predisposition to what and why

Answer 11

LA enlargement- afib. Blood stasis in distended LA- thrombi, need anticoag

Question 12

Mitral stenosis symptoms

Answer 12

DOE when CO inc, severe leads to HF

Question 13

Mitral stenosis anesthesia goals: 3 main

Answer 13

Slow (avoid ST/RVR In afib), tight (avoid over transfusion/head down), full (avoid drug induced dec SVR)

Question 14

MS: avoid what things that might exacerbate condition in anesthesia

Answer 14

Hypoxemia +/- hypoventilation, could exacerbate pulm htn and evoke right vent failure

Question 15

Mitral stenosis induction: avoid what 2 things

Answer 15

IV drugs that are unlikely to inc HR (ketamine) or abruptly decrease SVR. Give etomidate or hi dose opioid

Question 16

Mitral stenosis: maintenance aims

Answer 16

Minimize sustained changes in HR/SVR/PVR and contractility. Good: BB and CCB.

Question 17

Mitral regurg patho

Answer 17

Rheumatic fever, almost always assoc w mitral stenosis

Question 18

Mitral regurg: __ overload by retrograde flow on portion of ___ into LA

Answer 18

LA volume, LV stroke volume

Question 19

Mitral regurg: how it shows on PA recording, size correlates to what

Answer 19

V wave= regurgitant flow. Size= magnitude of regurg flow

Question 20

Mitral regurg: anesthesia management 3 main goals

Answer 20

Fast (avoid sudden hr decrease), full (avoid sudden SVR decrease), forward (dont want myo dep- IA)

Question 21

Mitral regurg: induction

Answer 21

Avoid excessive changes in SVR or HR decrease

Question 22

Mitral regurg: maintenance: influenced by what

Answer 22

LV dysfunc. If not severe: NO + iso

Question 23

Mitral regurg: LV dysfunc severe, do which technique

Answer 23

Opioid, minimizes myo depression.

Question 24

AS: patho

Answer 24

Degen/calcification d/t aging. Bicuspid valve. RA or endocarditis

Question 25

AS: gradient and size. Triad

Answer 25

<1 cm, >50 mmHg. Angina in absence of ischemia, DOE, syncope

Question 26

AS anesthesia management goals

Answer 26

Avoid further CO decrease. Maintain NSR, avoid tachy/bradycardia, avoid sudden SVR decrease, optimize volume to maintain venous return/LV fillling

Question 27

AS: which kind of anesthesia preferred

Answer 27

General over epidural/spinal to avoid SVR decrease

Question 28

Aortic regurg patho

Answer 28

Acute (infective, endocarditis, trauma, thoracic aneurysm dissection), or chronic (RF prior, systemic htn)

Question 29

Aortic regurg: anesthesia management goals

Answer 29

Avoid sudden HR decrease, SVR increase, minimize drug induced myo depression

Question 30

Aortic regurg: induction w which drugs

Answer 30

Maintain forward left ventricular stroke volume

Question 31

Aortic regurg: anesthesia maintenance

Answer 31

W NO + volatile (iso). If myo compromised use opioid alone maybe

Question 32

Aortic regurg: what is imp for maintaining L SV

Answer 32

IV fluid volume and prompt blood replacement

Question 33

Aortic regurg: tx what promptly w what

Answer 33

Bradycardia, glyco unless severe or glyco fails then go to atropine

Question 34

Tricuspid regurg patho

Answer 34

Usually functional. Dilation of RV d/t pulm htn. RV vol overload. Well tolerated

Question 35

Tricuspid regurg anesthesia management

Answer 35

Maintain IV fluid vol, avoid venous return drop, avoid hypoxia and hypercarbia