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942 > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

Primary or secondary valve HD:

-leaflets or anchoring and supporting structures are damaged (do not function properly)

A

primary valve dysfunction

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2
Q

AS: “adequate assessment of valvular stenosis” include these two

A
  1. flow rates across valve
  2. pressure gradient
    (both via ECHO or Cath)
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3
Q

how does bradycardia/tachycardia effect regurgitant flow/fraction, ejection and myocardial O2 demand

A

brady - increased regurgitant flow/fraction
tachy - shortens ejection and inc O2 demand
- detrimental in aortic stenotic lesions

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4
Q

MVP medication tx

-even thou majority do not need tx due to asypmtomatic

A

beta blocker

  • inhibit autonomic imbalance
  • may INC EDV -> DEC degree of prolapse
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5
Q

MVP: characteristic murmur

A

midsystolic click and late systolic murmur

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6
Q

Class III of NYHA coincides with which stage of ACCF/AHA stage of HF

A

C. Structural HD with prior or current symptoms of HF

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7
Q

regurgitant fraction parameters of mild, moderate and severe

A

mild < 30%
moderate 30-60 %
severe > 60%

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8
Q

Magnitude of AR reduced by:

A

tachycardia
peripheral vasodilation
chronic ventricular overload

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9
Q

AS: preload/LVEDV goal; fluids

A

maintain sufficient preload

normovolemia

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10
Q

systemic eval of primary valvular dysfunction of status of LV loading includes 3 things

A
  1. LV overload
  2. pressure overloading (aortic stenosis)
  3. volume underloading (mitral stenosis)
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11
Q

Class II of NYHA coincides with which stage of ACCF/AHA stage of HF

A

B. Structural HD but w/o signs or Sx of HF

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12
Q

MR: common dysrhythmia

A

afib

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13
Q

aortic and mitral insuff: hemodynamic and HR goal

A

reduced afterload

faster HR - shortens time for regurgitation

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14
Q

MS: timeline of stenosis post RHD and appearance of Sx

A

2 years post RHD

Sx develop 20-30 years after initial rheumatic fever

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15
Q

(Primary(anatomic) or functional) MVP

-redundant and thickened leaflets

A

primary (anatomic) MVP

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16
Q

MR: Implications of PAP measurements of LVEDV in chronic vs acute

A

acute MR works well

chronic MR poor measure of LVEDV

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17
Q

MS: volatile anethetics implications

A

nitrous - narcotic w/ low volatile

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18
Q

AS: why is bradycardia not desirable

A

< 60 bmp

- prolonged filling time -> ventricular distension, which can further decrease CPP (esp. subendocardium)

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19
Q

MR: EF and end-systolic dimension correlate with no improvement w/ surgery

A

EF < 30%

LV end-systolic dimensions > 55 mm

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20
Q

causes of MR (excluding obvious ones)

A

myxomatous degeneration
ankylosing spondylitis
carcinoid syndrome

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21
Q

NY Heart Association Functional HD classification related to exercise tolerance: Describes Class IV

A

symptoms AT REST

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22
Q

MAC in MVP

A

low conc (0.5 MAC) can decrease regurge fraction at low dose

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23
Q

MR: PCWP waveform characteristic

A

presence of V wave
not necessarily how much regurge volume but
indicates LA compliance in relationship to regurge volume

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24
Q

AR: long term tx that may delay need for surgery in asymptomatic patients with good LV function

A

nifedipine or hydralazine

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25
Q

in AS: what happens with LVEDV in early vs late stage

A

AS: LVEDV normal till late stage

volume late; pressure early

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26
Q

MS orifice reduction

A

from 4-6 cm2 to < 1.5 cm2

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27
Q

TR: hypercarbia and hypoxemia may cause this to PAP

A

INC PAP (avoid this)

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28
Q

AR: choice of anesthetic techinque in severe ventricular dysfunction

A

opioid-based

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29
Q

summary of MVP IE prophylaxis

A

only give to those with underlying cardiac conditions associated with HIGH risk outcomes from infectious endocarditis

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30
Q

treatment of pulmonic stenosis

A

surgery to relieve obstruction

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31
Q

chronic vs acute MR

A 
reduced CO (chronic)
pulm edema (acute)
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32
Q

MR: regurgitant fraction measured by 2 ways

A

pulsed doppler echo

cardiac cath

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33
Q

MR: neuraxial recommendations

A

Not CI but potential exists for profound hypotension w/ SNS depression

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34
Q

AR: LV dysfunction associated S/S

A

dyspnea
orthopnea
fatigue
coronary ischemia

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35
Q

narrowing of valvular orifice
restricted flow when valve open
inc flow resistance and turbulence
… describes what valve disease

A

valvular stenosis

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36
Q

AR: volume of regurgitation depends on 3 things:

A
  1. time available for regurge flow (HR)
  2. pressure gradient (Ao valve) pressure btw aorta and LV depends on SVR
  3. degree of AO valve imcompetence
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37
Q

which lesions progress faster (stenotic or regurgitant lesions)?

A

stenotic

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38
Q

AR: muscle relaxer choices

A

use non-depolarizers (Succs = bradycaria risk)

pancuroniium is desirable = offsets vagolytic effects of narcotics

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39
Q

AS: any change in basic hemodamic (__, __, __, __) can cause irreversible myocardial deterioration

A

HR
Rhythm
LVEDV
CPP

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40
Q

Chronic MR: secondary PA HTN dt

A

intimal fibroelastosis

-permanent vascular damage, fibrous scaring of intima and media per google

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41
Q

AS: pulse pressure

A

narrow

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42
Q

(Primary(anatomic) or functional) MVP

-mild bowing and normal leaflets

A

functional MVP

normal variant

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43
Q

MR: hemodynamic goals

A 
INC HR (normal or slightly higher)
DEC afterload
avoid HIGH PVR
Preload: NORMAL to INC'd
Contractility: maintain
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44
Q

how does anesthesia affect sympathetic tone and what implications for valvular HD

A

decreased sympathetic tone during anesthesia may cause severe myocardial dysfunction

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45
Q

MVP: hemodynamic conditions that DEC preload and incidence of MV eversion are due to:

A 
INC contractility
DEC SVR
head up/sitting position
NTG/Nipride
hypovolemia
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46
Q

MS: pulm edema occurs when these pressure changes occur btw PVP and plasma oncotic pressures

A

PVP > POP

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47
Q

MVP: EKG changes

A

PVC
repolarization abnormalities
prolonged QT

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48
Q

presence of bicuspid valve more common to occur when during aging/life

A

early life

btw 30-50 yo

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49
Q

AR: surgical recommendation for asymptomatic

A

surgery recommended BEFORE permanent dysfunction even if not symptomatic.
ACUTE AR - immediate surgery

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50
Q

MS: anticoagulants in minor surgery (dc or continue)

A

continue unless obvioulsy major blood loss anticipated

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51
Q

less common causes of MS

A
  1. carcinoid syndrome
  2. LA myxoma
  3. severe mitral annular calcification
  4. endocarditis
  5. cor triatriatum (congenital defect)
  6. rheumatic arthritis
  7. systemic lupus erythematosus
  8. congenital
  9. iatrogenic MS after MV repair
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52
Q

on PA chest what indicates cardiomegally

A

heart size is 50 % of internal width of thoracic cage

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53
Q

75% of symptomatic patients will die within __ years w/o valve replacement

A

3 years

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54
Q

which valves and dysfunctions produce pressure overload

A

mitral stenosis

aortic stenosis

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55
Q

TR: treatment

A

find cause of lesion
improve lung function
relieve LV failure
reduce PHTN

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56
Q

AS: LV consequences

A
  1. dec compliance
  2. remodeling
  3. dec. contractility of myocardium
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57
Q

valvular HD: cardiac cath

A

measure transvalvular gradients
estimate degree of regurgitation
visualize coronary arteries
determine intracardiac pressures

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58
Q

8 points on systemic eval of primary valvular dysfunciton

A
  1. category (stenosis, insuff, mixed)
  2. status of LV loading
  3. acute vs chronic evolution
  4. cardiac rhythm and effect on diastolic filling time
  5. LV function
  6. secondary pulm vasc and RV function
  7. HR
  8. periop anticoagulation
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59
Q

MS: PA catheter risks w/ presence of PHTN

A

PA rupture!

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60
Q

MVP: how does PPV affect VR

A

PPV blunts decrease in VR and helps prevent increase in degree of prolapse

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61
Q

MS: tx (HR)

A

prevent tachycardia (reduces filling time)

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62
Q

Most common feature of AR

A

WIDE PP

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63
Q

major complications of TAVI (transcatheter aortic valve implantation)

A

stroke, cognitive dysfunction, aortic dissection, bleeding, femoral/inguinal artery injury, perivalvular leaks

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64
Q

MR: preop sedation and anticholinergics use recommendations/guidelines

A

okay to use

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65
Q

MS: PHTN and RVF may be caused by

A 
hypercarbia
hypoxmia
lung hyperinfilration
increase in "lung water"
(think inotropic and; pulm vasodilating drugs)
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66
Q

MVP prognosis

A

usually benign

can have complications: cerebral embolic events, infective endocarditis, severe MR, dysrhythmias, sudden death

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67
Q

chronic MR (which type of LVH: concentric or eccentric)

A

eccentric

-w/ progressive contractility impairment

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68
Q

AR: biphasic pulse, second peak dt strong LV contraction, occurs in significant AR, double pulse felt dt back flow in early diastole

A

Biseferien’s pulse

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69
Q

AR: RV and pulm vascular circuit usually spared in chronic AI until secondary (functional) MR occurs. This results in _______ (related to MV annulus change)

A

dilation of mitral valve annulus

-> gradual increase in LAP and PAP caused by MR eventually causes pulm HTN (functional/secodary MR definition)

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70
Q

compliance of LA in chronic vs acute MR

A

acute - non compliant LA

chronic - compliant LA

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71
Q

AS: avoid which muscle relaxors

A

histamine releasing (atricurium)

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72
Q

MR: induction recommendation

A

prevent DEC SVR and DEC HR

pancuronium maintains HR

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73
Q

MR: induction and paralytic recommendation

A

avoid bradycardia and significant increase in afterload

pancuronium maintains HR

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74
Q

treatment options in symptomatic MR

A

ACE inh or B-blocker (coreg)
biventricular pacing
improve sx and exercise tolerance

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75
Q

AS: what happens to pressure gradient btw LA and LV

A
  1. decreases (less filling into LV less pressure)
  2. ventricular filling dependent on normal atrial contraction
  3. loss of atrial systole = CHF, hypotension
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76
Q

functional MVP usually seen in this population

A

women < 45 yo

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77
Q

MS: reversal from NMB implications

A

avoid tachycardia from anticholinergic

give anticholinergics sloooowly

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78
Q

MR: consequences of dysrhythmia

A

loss of atrial kick
PULM congestion
LA/LV overload
LOW CO

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79
Q

AS: hemodynamic parameters (diastolic time, CPP) = decreases myocardial O2 supply

A

decreased
-diastolic time
+ dec CPP

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80
Q

“2 factors” of aortic stenosis (assuming she meant risk factors”

A
  1. degeneration and calcification of leaflets (aging process)
  2. presence of bicuspid valve (if only 2 leaflets, more work split btw 2 leaflets instead of usual 3)
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81
Q

AS: HR goal

A

NSR

70 - 80 BMP

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82
Q

which valves and dysfunctions produce volume overload

A

mitral regurgitation

aortic regurgitation

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83
Q

MS: drugs to avoid

A

avoid ketamine

avoid histamine producing NMBs

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84
Q

acute MR choice med class

A

vasodilator

-no benefit for long term in asymptomatic pts w/ chronic MR..

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85
Q

AR: maintenance anesthetic

and in Severe AR

A

N2O + volatile
or Opioid
Severe AR: high dose opioid (avoid brady)

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86
Q

most common valvular disease in elderly and

most common cause of obstruction to LV outflow

A

aortic stenosis

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87
Q

MS presents a FIXED resistance to v-inflow
atrial systole accounts for __ to __ % of LVEDV
what is this accomplishing in regard to flow?

A

20 - 30%

most pressure generated by atria is to overcome the stenotic valve RATHER than producing better forward flow

88
Q

Pulm Valve regurgitation causes

A

mainly PHTN that caused annular dilation of pulm valve
other causes: connective tissues disease, carcinoid syndrome, IE, rheumatic HD
*rarely symptomatic

89
Q

failure of aortic leaflet coaptation due to diseases of aortic leaflets or aortic root (coexisting disease) describes which valvular disease

A

aortic regurgitation

90
Q

MVP prevalence in..

A

women 3x more likely
familial predisposition
marfan’s, rheumatic, thyrotoxicosis, SLE, pectus excavatum, hyphoscoliosis

91
Q

MVP: things that DEC LV emptying and INC LV volume and reduce degree of MVP

A

HTN
vasoconstriction
drug-induced myocardial depression
volume resuscitation

92
Q

AR: hemodynamic changes (INC or DEC)

  • LV volume
  • SV
  • Effective SV
  • Ao diastolic pressure
  • LVET
  • Diastolic time
  • systolic pressure
  • LVEDP
A
  • LV volume INC
  • SV INC
  • Effective SV DEC (fatigue)
  • Ao diastolic pressure DEC (low CBF - chest pain in absence of CAD)
  • LVET INC
  • Diastolic time DEC
  • systolic pressure INC
  • LVEDP INC (dyspnea)
93
Q

clinical scenario of severe MS

A

PULM congestion
DEC CO
RV overload and failure

94
Q

MVP: dysrhythmia more common in what position

A

sitting

lidocaine and b-blockers

95
Q

indicates severe transvalvular pressure gradient in mitral stenosis (mmHg)

A

> 10 mmHg

96
Q

AS: what changes occur in

  • pulse pressure
  • systolic pressure rise
  • dicrotic notch
A
  • DEC pulse pressure
  • systolic pressure rise DELAYED
  • dicrotic notch SMALL or ABSENT
97
Q

primary or secondary valve HD:

-valve not directly damaged

A

secondary valve dysfunction

98
Q

AR: treatment (medical)

A
  1. decrease SYS HTN and LV wall stress
  2. improve LV function
  3. Vasodilator (Nipride) + inotrope (dobutamine) may help LV SV and reduce regurg volume
99
Q

MS: anesthetic managment

A

NSR at low normal HR (tachy + LOW PB = Pulm EDEMA)
adequate LVEDV w/o Pulm congestion
avoide extreme reduction in contractility
reduce afterload (RV and LV)
cardiovert unstable atrial arrhythmias
LOW BP - small neo doses, consider vasopressin (minimal effect on PAP)

100
Q

AS: hemodynamic parameters (systolic pressure, LV mass, LVET) that inc myocardial consumption (from patho schematic)

A

Increased

  • systolic pressure
  • LV mass
  • LVET
101
Q

anesthetic management pearls for AR (HR, afterload, rhythm, preload..)

A
  • HR - slightly higher than normal (80-110)
  • afterload - DEC, esp diastolic pressure (dec SVR = dec AoDP = DEC Ao - LV gradient
  • avoid myocardial depression
  • maintain NSR
  • maintain/INC preload
102
Q

AS: afterload goal

A

maintain or allow slight increase

103
Q

Ao: normal flow rate

A

250 ml/min

-during interval of ventricular systole (80ml x 0.32 sec)

104
Q

which leaflets of tricuspid valve are displaced toward apex of the RV in TR

A

septal posterior

105
Q

“one prominent feature of AS”

A

dec LV compliance dt hypertrophy

106
Q

in AS: LVEDP (early vs late stage)

A

AS: LVEDP high in early stage

volume late; pressure early

107
Q

AS: summary of anesthetic key maintenance implications

A
  1. immediately tx change in HR, rhythm, SVR, BP and LVEDV
  2. maintain NSR, avoid tachy or brady
  3. avoid hypotension
  4. optimize intravascular fluid to maintain VR and LV filling
108
Q

Valvular HD: meds used for BP/afterload reduction

A

ACE inh

Vasodilators

109
Q

AR: choice/preferred inh agent

A

ISO

  • ability to INC HR and DEC SVR
  • produces minimal myocardial depression in lower doses
  • Thurman says they are all good choices (ISO, DES, SEVO for same reasons)
110
Q

MVP: GA or regional

A

all okay

LV is fine

111
Q

AS: valve area must be constricted at least __ % before gradient is significant to cause symptoms at rest

A

50%

112
Q

AR: Ao ROOT abnormalities cause by:

A
  1. idiopathic Ao root dilation
  2. HTN-induced aortoannular ectasia
  3. Ao dissection
  4. syphilitic aorititis
  5. Marfan’s syn
  6. Ehler-Danlos syn
  7. Rheumatoid arthritis
  8. psoriatic arthritis
    j9. ankylosing spondylitis
113
Q

MS: EKG characteristics

A

Broad, notched P-wave (LA enlarged)

114
Q

AR: PCW changes in significant AR

A

PROMINENT V wave

115
Q

acute AR: hemodynamic changes

A
  • rapid inc in LVEDP
  • decreased AoDP
  • CBF compromised = MI
  • functional MR poorly tolerated bc of noncompliant LA (pulm edema)
116
Q

MS: symptomatic when orifice is < ___ % of normal

A

<50 %

117
Q

AS: systolic ejection time (up/down)

A

prolonged

118
Q

AS: murmur .. (systole or diastole) and radiates

A

systolic murmur in aortic area
may radiate to neck and mimic carotid bruit
-but, may have presence of carotid disease as well

119
Q

MS: aline and PCW characteristics

A

prominent a wave

y descent present in PCW waveform

120
Q

MS: implications with atrial dysrhythmias

A

afib - from atrial distention
loss of atrial KICK (diastolic filling ONLY maintained by inc in LAP — BUT mean LAP is limited by PULM congestion at pressures > 25 mmHg)

121
Q

MS: Sx develop when valve area =

A

< 1.5 cm2

122
Q

most common form of valvular HD in U.S. accounting for 1 - 2.5% of population

A

MVP

123
Q

AS symptoms develop when valve area is

A

< 1 cm2

124
Q

NH: the major hemodynamic aberration related to AR occurs during ___ (cardiac cycle term)

A

diastole

125
Q

basic derangement of MR

A

DEC forward LV SV and CO

double outlet during systole

126
Q

pulmonic stenosis: causes

A

usually congenital
corrected in younger ages
aquired: RF, carcinoid syn, IE, previous surgery/interventions

127
Q

AS: concentric LVH due to: 6 things

A
  1. pressure overload
  2. static exercise
  3. HTN
  4. pathophysiological conditions
  5. relative inc in connective tissue
  6. fibrosis
128
Q

indicates severe transvalvular pressure gradient in aortic stenosis (mmHg)

A

> 50 mmHg

129
Q

MS: as valve area narrows to 1.5 to 2.5 cm2 these changes will occur to HR and CO

A

INC HR

INC CO

130
Q

MVP induction to avoid significant DEC SVR

A

etomidate -minimal depression/change in SNS

ketamine - may INC prolapse and regurgitation

131
Q

AR:
pulse pressure
DBP
pulse palpation

A

-Signs of hyperdynamic circulation
pulse pressure (WIDE)
DBP (LOW)
pulse palpation (BOUNDING)

132
Q

what determines choice/level of monitoring

A

severity of disease

133
Q

MS: surgical indications

A

worsesned Sx

PHTN

134
Q

AS: neuraxial blockade implications

A
  • use with extreme precautions
  • SYMPATHECTOMY: potential dec in SVR
  • HR may not be able to compensate for vasodilation
  • Epidural may be desirable (slower hemodynamic changes- but may still lack compensation for HR dec!)
135
Q

aortic and mitral stenosis: HR goal and why

A

Slow HR

prolong diastole = improved coronary BF

136
Q

MVP: perioperative events that enhance LV emptying
SNS
SVR
Posture

A

INC SNS = INC contractility
DEC SVR
UPRIGHT Posture

137
Q

chronic MR usually a result of

A

Rheumatic Fever

138
Q

most common cause of isolated MR

A

MVP

139
Q

MS: if MV area narrowed to < 1cm2, mean LAP of ___ mmHg is necessary for maintaining even an adequate resting CO

A

25 mmHg

140
Q

Severe MR: hemodynamic changes w/ vasodilators (LV flow, LAP and LVEDV

A

titrated to maximize forward LV flow and DEC LVEDV and LAP

141
Q

3 causes of secondary valve dysfunction

A

ventricular dilation - creates MV insuff
retrograde aortic dissection - creates aortic insuff
papillary muscle infarction

142
Q

aortic stenosis causes are almost always (3 things)

A

congenital
rheumatic
degenerative
(others include HTN, high cholest, infective endocarditis)

143
Q

MVP: dec SVR treated with what

A

fluids

144
Q

MS post op: pain and hypoventilation may cause: may need mechanical vent

A

tachycardia

INC PVR

145
Q

AR: regurgitant volume depends on what 3 things

A
  1. HR (diastolic time) slow HR = more regurge
  2. diastolic pressure gradient across the aortic valve (Ao DP - LVEDP)
  3. degree of Ao valve incompetence
146
Q

MR: survival prolonged if these changes in EF and LV end-systolic dimensions are present

A

EF NOT < 60%

LV end-systolic dimension NOT > 45 mm (normal <40)

147
Q

MVP IE prophylaxis in genitourinary or GI tract procedure

A

NOT recommended bro

148
Q

diastolic rumble in with valvular disease
specific name of murmur
cause

A

AR
Austin Flint Murmur
- caused by fluttering of MV
- Sx may not appear until LV dysfunction is present

149
Q

characteristics of valve in MS
Thickening
commisural changes
annulus and leaflet changes

A

Thickening DIFFUSE
commisural FUSION changes
CALCIFICATION of annulus and leaflet changes

150
Q

MVP: dx of mm of prolapse into mitral annulus

A

2 mm or more above mitral annulus

151
Q

broad notch P-wave called this

A

P mitrale
presence of LA enlargement
typical in MV disease

152
Q

MR + MS = (what changes in PVR/RV)

A

EXTREMELY HIGH

if you just said High - you are incorrect. Jk

153
Q

valvular HD: color flow doppler imaging assesses

A 
valve area 
transvalvular gradients
degree of regurgitation
flow velocity and direction
cardiac function
154
Q

preop eval includes 3 things

A
  1. severity of disease
  2. degree of imparied myocardial contractility
  3. presence of assoc. organ system disease
155
Q

MS: diastolic rumble heard where

A

apex

156
Q

NY Heart Association Functional HD classification related to exercise tolerance: Describes Class III:

A

symptoms with MINIMAL (less than ordinary) activity but comfortable at rest

157
Q

unique MVP problems (related to rhythm change with GA)

A

-PVC’s with GA (may not respond to lidocaine - beta blocker drug of choice)

158
Q

TR general causes

A

dt tricuspid annular dilation from RV enlargement or PHTN

159
Q

triad of symptoms in AS

which of the 3, indicates HF

A

chest pain
syncope
dyspnea on exertion (HF)

160
Q

MVP IE prophylaxis for these high risk cardiac conditions

A

prosthetic valve
hx of IE
congenital CHD
cardiac transplant with valve disease

161
Q

pressure gradient and valve area in severe AS

A

transvalvular pressure gradient > 50 mmHg

+ valve area < 0.8 cm2

162
Q

MS: diagnostic murmur sound

A
  • opening SNAP in early diastole (disappears in calcification + DEC motility)
  • diastolic murmur best in apex
163
Q

common cause of MS
male or females?
what other patient population

A

RHD
females
dialysis - dependent

164
Q

MS: neuraxial okay?

A

yes, in absence of anticoagulation

165
Q

TR “other causes”

A 
IE
carcinoid syndrome
rheumatic HD
tricuspid valve prolapse
Ebstein's anomaly
marfan's (connective disorder)
myxomatous degeneration
injury (pacer lead, central line)
mild TR normal in any age and athletes
166
Q

NY Heart Association Functional HD classification related to exercise tolerance: Describes Class II:

A

symptoms with ORDINARY activity but comfortable at rest

167
Q

Class IV of NYHA coincides with which stage of ACCF/AHA stage of HF

A

D. Refractory HF requiring specialized interventions

168
Q

AR: a-line changes
pulse pressure
rise
systolic peak

A

pulse pressure WIDE
rise RAPID
systolic peak HIGH

169
Q

AS: why is tachycardia not desirable

A

detrimental

  • decrease in diastolic filling time (low preload)
  • dec time for coronary perfusion!
  • > 110 dec SET and CO
170
Q

AR: monitor shows bradycardia or junctional rhythm - what do you do?

A

prompt atropine

171
Q

ESV changes in initial vs late MR progression

A

initial - normal ESV

late - INC ESV

172
Q

neuraxial blockade in AR: implications

A

appropriate anesthetic choice (depending on invasiveness of procedure)
- DEC SVR from sympathetic blockade may reduce the degree of regurgitation

173
Q

most common hemodynamic derangement from primary dysfunction of which valves

A

mitral

aortic

174
Q

MS: and N2O implications

A

in PHTN: N2O can cause Pulm vasoconstriction

175
Q

valvular HD: radiography useful to assess

A

cardiac silhouette

pulm vascular congestion

176
Q

MR: dx murmur

A

holosystolic
apical
radiation to axilla

177
Q

AS: which patients might benefit from aortic valve replacement

A

exercise induced symptomatic patients

178
Q

chronic overload from AR causes what time of LVH (ecc/conc?)

A

eccentric and chamber dilation

179
Q

AV valve area associated with sudden death

A

0.7 cm2

180
Q

__ % of pts with aortic stenosis and greater than age __ usually have associated ischemic HD

A

50 50

181
Q

AR: leaflet abnormalities caused by: (4)

A
  1. infective endocarditis
  2. rheumatic fever
  3. bicuspid aortic valve
  4. anorexic drugs (phenterimine)
182
Q

valvular HD: EKG useful to assess

A

LVH
atrial enlargement
axis deviation
cardiac rhythm

183
Q

MR: regurgitant fraction determined by 4 factors:

A
  1. valve area
  2. LA and LV pressure gradient (inotropic state/peak sys pressure, LA/pulm vein compliance)
  3. length of systole (time of regurge)
  4. SVR (aortic impedence)
184
Q

MS: take-away about PCWP readings with LA hypertrophy and INC LAP and LVEDP/LVEDV readings

A

LVEDP and LVEDV overestimated

185
Q

NY Heart Association Functional HD classification related to exercise tolerance: Describes Class I:

A

asymptomatic

186
Q

Valvular HD: 3 drugs used during heart failure

A

diuretics
inotropes
vasodilators

187
Q

how many classes in functional classification

A

I II III IV

188
Q

MS is severe when transvalvular gradient is ____.

Normally ____

A

> 10 mmHg

5 normal

189
Q

chronic AR: hemodynamic changes
LV pressure
LV volume
SV

A

LV pressure INC
LV volume INC
SV INC

190
Q

most common cause of aortic stenosis

A

congenital defect resulting in bicuspid AV (esp in males) and sequelae of rheumatic valvular HD (rheumatic is commonly associated w/ mitral valve involvment - so isolated aortic valve HD in rheumatic HD is rare)

191
Q

AR: diagnostic murmur and where

A

diastolic murmur

RSB

192
Q

New Tx for valvular disease

A

TAVI (transcatheter aortic valve implantation)

lower 30 day/1-year mortality than ballon vulvotomy or medical tx

193
Q

AS: treatment of hypotension

A

volume and neo

-irreversible ischemia if ur too slow/not aggressive in ur treatment

194
Q

High LAP can cause ____ _____ (condition) which eventually occurs and causes PULM HTN

A

pulmonary fibroelastosis

195
Q

instead of high dose inhalation agents (VASODILATION) may use ___ as alternative

A

opioids (high dose)

inh/narc combo

196
Q

most common cause of TR

A

rheumaic HD with co-existing TR and often mitral or aortic valve disease

197
Q

TR characteristic murmur and where

A

holosystolic

right or left SB or xiphoid area/soft or absent in TR is even severe

198
Q

AS: CXR feature

A

prominent ascending aortic arch dt aortic dilation

199
Q

Class I of NYHA coincides with which stage of ACCF/AHA stage of HF

A

A. at risk for HF but without structural HD or symptoms of HF

200
Q

MS: the valve area of ___ causes prolonged diastolic filling time and elevated mean LAP are incapable of maintaining normal LVEDV, and decreasses in LV volume occur = symptoms at REST

A

< 1 cm2

201
Q

fluid goal in TR

A

maintain volume/CVP high-normal

facilitates adequate RV and LV filling

202
Q

valvular HD: one dysfunction dominates other dysfunction. Based on severity of clinical symptoms. Can have stenosis w/ insufficiency or insufficiency w/ stenosis describes which valvular classification.

A

Mixed Lesions

203
Q

MR: high SVR consequences

A

LV decompenstion

  • reduce afterload w/ vasodilators (nipride +/- inotropic) to improve LV function
  • EXTREME reduction in BP = low CBF, low CO
204
Q

AS always associated w/ some degree of aortic regurge (T/F)

A

T - almost always

205
Q

Ao: normal valve area

A

2.5 - 3.5 cm2

206
Q

valvular classificationn (type of lesions) based on 3 things

A
  1. stenosis
  2. insufficiency
  3. mixed
207
Q

AS: what does LAP do to accomadate LV filling

A

LAP inc to maintain CO

- if LVEF is < 40%, CO maintained ONLY with inc LAP (25-30%)

208
Q

LAP > ___ mmHg can cause inc PAP

A

18

increases PVR -> RV failure

209
Q

TR: Nitrous implications

A

weak PA vasoconstrictor
could INC TV regurgitation
–AVOID –

210
Q

MS: preop anxiolytic implications

A

increases susceptibility to ventilator-depressant effect

211
Q

TR surgery prevalence

A

rarely done

212
Q

NH on MVP antibiotic prophylaxis in dental procedure

A

Infective Endocarditis (IE) for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest adverse outcomes from IE

213
Q

MS: narrowed valve; 2 hemodynamic consequences (hint: gradient and flow/LV volume)

A
  1. gradient develops across valve orifice (compensatory change to maintain flow)
  2. flow is restricted and LV volume DEC
214
Q

MVP pathophys

A

myxomatous degeneration of cusps replacing normal fibrous tissue

  • leaflets become supple and redundant
  • affect chordae tendineae - more pliable and elongated
215
Q

MVP: this population may have CHF, exercise intolerance, orthopnea, DOE, on diuretics/ACEi, midsystolic to holosystolic murmur, S3 gallop and sx of Pulm edema

A

older men

942 (7 decks)

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