Valvular Disease Flashcards
(215 cards)
1
Q
Primary or secondary valve HD:
-leaflets or anchoring and supporting structures are damaged (do not function properly)
A
primary valve dysfunction
2
Q
AS: “adequate assessment of valvular stenosis” include these two
A
- flow rates across valve
- pressure gradient
(both via ECHO or Cath)
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
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
5
Q
MVP: characteristic murmur
A
midsystolic click and late systolic murmur
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
7
Q
regurgitant fraction parameters of mild, moderate and severe
A
mild < 30%
moderate 30-60 %
severe > 60%
8
Q
Magnitude of AR reduced by:
A
tachycardia
peripheral vasodilation
chronic ventricular overload
9
Q
AS: preload/LVEDV goal; fluids
A
maintain sufficient preload
normovolemia
10
Q
systemic eval of primary valvular dysfunction of status of LV loading includes 3 things
A
- LV overload
- pressure overloading (aortic stenosis)
- volume underloading (mitral stenosis)
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
12
Q
MR: common dysrhythmia
A
afib
13
Q
aortic and mitral insuff: hemodynamic and HR goal
A
reduced afterload
faster HR - shortens time for regurgitation
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
15
Q
(Primary(anatomic) or functional) MVP
-redundant and thickened leaflets
A
primary (anatomic) MVP
16
Q
MR: Implications of PAP measurements of LVEDV in chronic vs acute
A
acute MR works well
chronic MR poor measure of LVEDV
17
Q
MS: volatile anethetics implications
A
nitrous - narcotic w/ low volatile
18
Q
AS: why is bradycardia not desirable
A
< 60 bmp
- prolonged filling time -> ventricular distension, which can further decrease CPP (esp. subendocardium)
19
Q
MR: EF and end-systolic dimension correlate with no improvement w/ surgery
A
EF < 30%
LV end-systolic dimensions > 55 mm
20
Q
causes of MR (excluding obvious ones)
A
myxomatous degeneration
ankylosing spondylitis
carcinoid syndrome
21
Q
NY Heart Association Functional HD classification related to exercise tolerance: Describes Class IV
A
symptoms AT REST
22
Q
MAC in MVP
A
low conc (0.5 MAC) can decrease regurge fraction at low dose
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
24
Q
AR: long term tx that may delay need for surgery in asymptomatic patients with good LV function
A
nifedipine or hydralazine
25
in AS: what happens with LVEDV in early vs late stage
AS: LVEDV normal till late stage
| volume late; pressure early
26
MS orifice reduction
from 4-6 cm2 to < 1.5 cm2
27
TR: hypercarbia and hypoxemia may cause this to PAP
INC PAP (avoid this)
28
AR: choice of anesthetic techinque in severe ventricular dysfunction
opioid-based
29
summary of MVP IE prophylaxis
only give to those with underlying cardiac conditions associated with HIGH risk outcomes from infectious endocarditis
30
treatment of pulmonic stenosis
surgery to relieve obstruction
31
chronic vs acute MR
```
reduced CO (chronic)
pulm edema (acute)
```
32
MR: regurgitant fraction measured by 2 ways
pulsed doppler echo
| cardiac cath
33
MR: neuraxial recommendations
Not CI but potential exists for profound hypotension w/ SNS depression
34
AR: LV dysfunction associated S/S
dyspnea
orthopnea
fatigue
coronary ischemia
35
narrowing of valvular orifice
restricted flow when valve open
inc flow resistance and turbulence
... describes what valve disease
valvular stenosis
36
AR: volume of regurgitation depends on 3 things:
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
37
which lesions progress faster (stenotic or regurgitant lesions)?
stenotic
38
AR: muscle relaxer choices
use non-depolarizers (Succs = bradycaria risk)
| pancuroniium is desirable = offsets vagolytic effects of narcotics
39
AS: any change in basic hemodamic (__, __, __, __) can cause irreversible myocardial deterioration
HR
Rhythm
LVEDV
CPP
40
Chronic MR: secondary PA HTN dt
intimal fibroelastosis
| -permanent vascular damage, fibrous scaring of intima and media per google
41
AS: pulse pressure
narrow
42
(Primary(anatomic) or functional) MVP
| -mild bowing and normal leaflets
functional MVP
| normal variant
43
MR: hemodynamic goals
```
INC HR (normal or slightly higher)
DEC afterload
avoid HIGH PVR
Preload: NORMAL to INC'd
Contractility: maintain
```
44
how does anesthesia affect sympathetic tone and what implications for valvular HD
decreased sympathetic tone during anesthesia may cause severe myocardial dysfunction
45
MVP: hemodynamic conditions that DEC preload and incidence of MV eversion are due to:
```
INC contractility
DEC SVR
head up/sitting position
NTG/Nipride
hypovolemia
```
46
MS: pulm edema occurs when these pressure changes occur btw PVP and plasma oncotic pressures
PVP > POP
47
MVP: EKG changes
PVC
repolarization abnormalities
prolonged QT
48
presence of bicuspid valve more common to occur when during aging/life
early life
| btw 30-50 yo
49
AR: surgical recommendation for asymptomatic
surgery recommended BEFORE permanent dysfunction even if not symptomatic.
ACUTE AR - immediate surgery
50
MS: anticoagulants in minor surgery (dc or continue)
continue unless obvioulsy major blood loss anticipated
51
less common causes of MS
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
52
on PA chest what indicates cardiomegally
heart size is 50 % of internal width of thoracic cage
53
75% of symptomatic patients will die within __ years w/o valve replacement
3 years
54
which valves and dysfunctions produce pressure overload
mitral stenosis
| aortic stenosis
55
TR: treatment
find cause of lesion
improve lung function
relieve LV failure
reduce PHTN
56
AS: LV consequences
1. dec compliance
2. remodeling
3. dec. contractility of myocardium
57
valvular HD: cardiac cath
measure transvalvular gradients
estimate degree of regurgitation
visualize coronary arteries
determine intracardiac pressures
58
8 points on systemic eval of primary valvular dysfunciton
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
59
MS: PA catheter risks w/ presence of PHTN
PA rupture!
60
MVP: how does PPV affect VR
PPV blunts decrease in VR and helps prevent increase in degree of prolapse
61
MS: tx (HR)
prevent tachycardia (reduces filling time)
62
Most common feature of AR
WIDE PP
63
major complications of TAVI (transcatheter aortic valve implantation)
stroke, cognitive dysfunction, aortic dissection, bleeding, femoral/inguinal artery injury, perivalvular leaks
64
MR: preop sedation and anticholinergics use recommendations/guidelines
okay to use
65
MS: PHTN and RVF may be caused by
```
hypercarbia
hypoxmia
lung hyperinfilration
increase in "lung water"
(think inotropic and; pulm vasodilating drugs)
```
66
MVP prognosis
usually benign
| can have complications: cerebral embolic events, infective endocarditis, severe MR, dysrhythmias, sudden death
67
chronic MR (which type of LVH: concentric or eccentric)
eccentric
| -w/ progressive contractility impairment
68
AR: biphasic pulse, second peak dt strong LV contraction, occurs in significant AR, double pulse felt dt back flow in early diastole
Biseferien's pulse
69
AR: RV and pulm vascular circuit usually spared in chronic AI until secondary (functional) MR occurs. This results in _______ (related to MV annulus change)
dilation of mitral valve annulus
| -> gradual increase in LAP and PAP caused by MR eventually causes pulm HTN (functional/secodary MR definition)
70
compliance of LA in chronic vs acute MR
acute - non compliant LA
| chronic - compliant LA
71
AS: avoid which muscle relaxors
histamine releasing (atricurium)
72
MR: induction recommendation
prevent DEC SVR and DEC HR
| pancuronium maintains HR
73
MR: induction and paralytic recommendation
avoid bradycardia and significant increase in afterload
| pancuronium maintains HR
74
treatment options in symptomatic MR
ACE inh or B-blocker (coreg)
biventricular pacing
improve sx and exercise tolerance
75
AS: what happens to pressure gradient btw LA and LV
1. decreases (less filling into LV less pressure)
2. ventricular filling dependent on normal atrial contraction
3. loss of atrial systole = CHF, hypotension
76
functional MVP usually seen in this population
women < 45 yo
77
MS: reversal from NMB implications
avoid tachycardia from anticholinergic
| give anticholinergics sloooowly
78
MR: consequences of dysrhythmia
loss of atrial kick
PULM congestion
LA/LV overload
LOW CO
79
AS: hemodynamic parameters (diastolic time, CPP) = decreases myocardial O2 supply
decreased
-diastolic time
+ dec CPP
80
"2 factors" of aortic stenosis (assuming she meant risk factors"
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)
81
AS: HR goal
NSR
| 70 - 80 BMP
82
which valves and dysfunctions produce volume overload
mitral regurgitation
| aortic regurgitation
83
MS: drugs to avoid
avoid ketamine
| avoid histamine producing NMBs
84
acute MR choice med class
vasodilator
| -no benefit for long term in asymptomatic pts w/ chronic MR..
85
AR: maintenance anesthetic
| and in Severe AR
N2O + volatile
or Opioid
Severe AR: high dose opioid (avoid brady)
86
most common valvular disease in elderly and
| most common cause of obstruction to LV outflow
aortic stenosis
87
MS presents a FIXED resistance to v-inflow
atrial systole accounts for __ to __ % of LVEDV
what is this accomplishing in regard to flow?
20 - 30%
| most pressure generated by atria is to overcome the stenotic valve RATHER than producing better forward flow
88
Pulm Valve regurgitation causes
mainly PHTN that caused annular dilation of pulm valve
other causes: connective tissues disease, carcinoid syndrome, IE, rheumatic HD
*rarely symptomatic
89
failure of aortic leaflet coaptation due to diseases of aortic leaflets or aortic root (coexisting disease) describes which valvular disease
aortic regurgitation
90
MVP prevalence in..
women 3x more likely
familial predisposition
marfan's, rheumatic, thyrotoxicosis, SLE, pectus excavatum, hyphoscoliosis
91
MVP: things that DEC LV emptying and INC LV volume and reduce degree of MVP
HTN
vasoconstriction
drug-induced myocardial depression
volume resuscitation
92
AR: hemodynamic changes (INC or DEC)
- LV volume
- SV
- Effective SV
- Ao diastolic pressure
- LVET
- Diastolic time
- systolic pressure
- LVEDP
- 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
clinical scenario of severe MS
PULM congestion
DEC CO
RV overload and failure
94
MVP: dysrhythmia more common in what position
sitting
| lidocaine and b-blockers
95
indicates severe transvalvular pressure gradient in mitral stenosis (mmHg)
> 10 mmHg
96
AS: what changes occur in
- pulse pressure
- systolic pressure rise
- dicrotic notch
- DEC pulse pressure
- systolic pressure rise DELAYED
- dicrotic notch SMALL or ABSENT
97
primary or secondary valve HD:
| -valve not directly damaged
secondary valve dysfunction
98
AR: treatment (medical)
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
MS: anesthetic managment
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
AS: hemodynamic parameters (systolic pressure, LV mass, LVET) that inc myocardial consumption (from patho schematic)
Increased
- systolic pressure
- LV mass
- LVET
101
anesthetic management pearls for AR (HR, afterload, rhythm, preload..)
- 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
AS: afterload goal
maintain or allow slight increase
103
Ao: normal flow rate
250 ml/min
| -during interval of ventricular systole (80ml x 0.32 sec)
104
which leaflets of tricuspid valve are displaced toward apex of the RV in TR
septal posterior
105
"one prominent feature of AS"
dec LV compliance dt hypertrophy
106
in AS: LVEDP (early vs late stage)
AS: LVEDP high in early stage
| volume late; pressure early
107
AS: summary of anesthetic key maintenance implications
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
Valvular HD: meds used for BP/afterload reduction
ACE inh
| Vasodilators
109
AR: choice/preferred inh agent
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
MVP: GA or regional
all okay
| LV is fine
111
AS: valve area must be constricted at least __ % before gradient is significant to cause symptoms at rest
50%
112
AR: Ao ROOT abnormalities cause by:
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
MS: EKG characteristics
Broad, notched P-wave (LA enlarged)
114
AR: PCW changes in significant AR
PROMINENT V wave
115
acute AR: hemodynamic changes
- rapid inc in LVEDP
- decreased AoDP
- CBF compromised = MI
- functional MR poorly tolerated bc of noncompliant LA (pulm edema)
116
MS: symptomatic when orifice is < ___ % of normal
<50 %
117
AS: systolic ejection time (up/down)
prolonged
118
AS: murmur .. (systole or diastole) and radiates
systolic murmur in aortic area
may radiate to neck and mimic carotid bruit
-but, may have presence of carotid disease as well
119
MS: aline and PCW characteristics
prominent a wave
| y descent present in PCW waveform
120
MS: implications with atrial dysrhythmias
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
MS: Sx develop when valve area =
< 1.5 cm2
122
most common form of valvular HD in U.S. accounting for 1 - 2.5% of population
MVP
123
AS symptoms develop when valve area is
< 1 cm2
124
NH: the major hemodynamic aberration related to AR occurs during ___ (cardiac cycle term)
diastole
125
basic derangement of MR
DEC forward LV SV and CO
| double outlet during systole
126
pulmonic stenosis: causes
usually congenital
corrected in younger ages
aquired: RF, carcinoid syn, IE, previous surgery/interventions
127
AS: concentric LVH due to: 6 things
1. pressure overload
2. static exercise
3. HTN
4. pathophysiological conditions
5. relative inc in connective tissue
6. fibrosis
128
indicates severe transvalvular pressure gradient in aortic stenosis (mmHg)
> 50 mmHg
129
MS: as valve area narrows to 1.5 to 2.5 cm2 these changes will occur to HR and CO
INC HR
| INC CO
130
MVP induction to avoid significant DEC SVR
etomidate -minimal depression/change in SNS
| ketamine - may INC prolapse and regurgitation
131
AR:
pulse pressure
DBP
pulse palpation
-Signs of hyperdynamic circulation
pulse pressure (WIDE)
DBP (LOW)
pulse palpation (BOUNDING)
132
what determines choice/level of monitoring
severity of disease
133
MS: surgical indications
worsesned Sx
| PHTN
134
AS: neuraxial blockade implications
- 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
aortic and mitral stenosis: HR goal and why
Slow HR
| prolong diastole = improved coronary BF
136
MVP: perioperative events that enhance LV emptying
SNS
SVR
Posture
INC SNS = INC contractility
DEC SVR
UPRIGHT Posture
137
chronic MR usually a result of
Rheumatic Fever
138
most common cause of isolated MR
MVP
139
MS: if MV area narrowed to < 1cm2, mean LAP of ___ mmHg is necessary for maintaining even an adequate resting CO
25 mmHg
140
Severe MR: hemodynamic changes w/ vasodilators (LV flow, LAP and LVEDV
titrated to maximize forward LV flow and DEC LVEDV and LAP
141
3 causes of secondary valve dysfunction
ventricular dilation - creates MV insuff
retrograde aortic dissection - creates aortic insuff
papillary muscle infarction
142
aortic stenosis causes are almost always (3 things)
congenital
rheumatic
degenerative
(others include HTN, high cholest, infective endocarditis)
143
MVP: dec SVR treated with what
fluids
144
MS post op: pain and hypoventilation may cause: may need mechanical vent
tachycardia
| INC PVR
145
AR: regurgitant volume depends on what 3 things
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
MR: survival prolonged if these changes in EF and LV end-systolic dimensions are present
EF NOT < 60%
| LV end-systolic dimension NOT > 45 mm (normal <40)
147
MVP IE prophylaxis in genitourinary or GI tract procedure
NOT recommended bro
148
diastolic rumble in with valvular disease
specific name of murmur
cause
AR
Austin Flint Murmur
- caused by fluttering of MV
- Sx may not appear until LV dysfunction is present
149
characteristics of valve in MS
Thickening
commisural changes
annulus and leaflet changes
Thickening DIFFUSE
commisural FUSION changes
CALCIFICATION of annulus and leaflet changes
150
MVP: dx of mm of prolapse into mitral annulus
2 mm or more above mitral annulus
151
broad notch P-wave called this
P mitrale
presence of LA enlargement
typical in MV disease
152
MR + MS = (what changes in PVR/RV)
EXTREMELY HIGH
| if you just said High - you are incorrect. Jk
153
valvular HD: color flow doppler imaging assesses
```
valve area
transvalvular gradients
degree of regurgitation
flow velocity and direction
cardiac function
```
154
preop eval includes 3 things
1. severity of disease
2. degree of imparied myocardial contractility
3. presence of assoc. organ system disease
155
MS: diastolic rumble heard where
apex
156
NY Heart Association Functional HD classification related to exercise tolerance: Describes Class III:
symptoms with MINIMAL (less than ordinary) activity but comfortable at rest
157
unique MVP problems (related to rhythm change with GA)
-PVC's with GA (may not respond to lidocaine - beta blocker drug of choice)
158
TR general causes
dt tricuspid annular dilation from RV enlargement or PHTN
159
triad of symptoms in AS
| which of the 3, indicates HF
chest pain
syncope
dyspnea on exertion (HF)
160
MVP IE prophylaxis for these high risk cardiac conditions
prosthetic valve
hx of IE
congenital CHD
cardiac transplant with valve disease
161
pressure gradient and valve area in severe AS
transvalvular pressure gradient > 50 mmHg
| + valve area < 0.8 cm2
162
MS: diagnostic murmur sound
- opening SNAP in early diastole (disappears in calcification + DEC motility)
- diastolic murmur best in apex
163
common cause of MS
male or females?
what other patient population
RHD
females
dialysis - dependent
164
MS: neuraxial okay?
yes, in absence of anticoagulation
165
TR "other causes"
```
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
NY Heart Association Functional HD classification related to exercise tolerance: Describes Class II:
symptoms with ORDINARY activity but comfortable at rest
167
Class IV of NYHA coincides with which stage of ACCF/AHA stage of HF
D. Refractory HF requiring specialized interventions
168
AR: a-line changes
pulse pressure
rise
systolic peak
pulse pressure WIDE
rise RAPID
systolic peak HIGH
169
AS: why is tachycardia not desirable
detrimental
- decrease in diastolic filling time (low preload)
- dec time for coronary perfusion!
- >110 dec SET and CO
170
AR: monitor shows bradycardia or junctional rhythm - what do you do?
prompt atropine
171
ESV changes in initial vs late MR progression
initial - normal ESV
| late - INC ESV
172
neuraxial blockade in AR: implications
appropriate anesthetic choice (depending on invasiveness of procedure)
- DEC SVR from sympathetic blockade may reduce the degree of regurgitation
173
most common hemodynamic derangement from primary dysfunction of which valves
mitral
| aortic
174
MS: and N2O implications
in PHTN: N2O can cause Pulm vasoconstriction
175
valvular HD: radiography useful to assess
cardiac silhouette
| pulm vascular congestion
176
MR: dx murmur
holosystolic
apical
radiation to axilla
177
AS: which patients might benefit from aortic valve replacement
exercise induced symptomatic patients
178
chronic overload from AR causes what time of LVH (ecc/conc?)
eccentric and chamber dilation
179
AV valve area associated with sudden death
0.7 cm2
180
__ % of pts with aortic stenosis and greater than age __ usually have associated ischemic HD
50 50
181
AR: leaflet abnormalities caused by: (4)
1. infective endocarditis
2. rheumatic fever
3. bicuspid aortic valve
4. anorexic drugs (phenterimine)
182
valvular HD: EKG useful to assess
LVH
atrial enlargement
axis deviation
cardiac rhythm
183
MR: regurgitant fraction determined by 4 factors:
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
MS: take-away about PCWP readings with LA hypertrophy and INC LAP and LVEDP/LVEDV readings
LVEDP and LVEDV overestimated
185
NY Heart Association Functional HD classification related to exercise tolerance: Describes Class I:
asymptomatic
186
Valvular HD: 3 drugs used during heart failure
diuretics
inotropes
vasodilators
187
how many classes in functional classification
I II III IV
188
MS is severe when transvalvular gradient is ____.
| Normally ____
> 10 mmHg
| 5 normal
189
chronic AR: hemodynamic changes
LV pressure
LV volume
SV
LV pressure INC
LV volume INC
SV INC
190
most common cause of aortic stenosis
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
AR: diagnostic murmur and where
diastolic murmur
| RSB
192
New Tx for valvular disease
TAVI (transcatheter aortic valve implantation)
| lower 30 day/1-year mortality than ballon vulvotomy or medical tx
193
AS: treatment of hypotension
volume and neo
| -irreversible ischemia if ur too slow/not aggressive in ur treatment
194
High LAP can cause ____ _____ (condition) which eventually occurs and causes PULM HTN
pulmonary fibroelastosis
195
instead of high dose inhalation agents (VASODILATION) may use ___ as alternative
opioids (high dose)
| inh/narc combo
196
most common cause of TR
rheumaic HD with co-existing TR and often mitral or aortic valve disease
197
TR characteristic murmur and where
holosystolic
| right or left SB or xiphoid area/soft or absent in TR is even severe
198
AS: CXR feature
prominent ascending aortic arch dt aortic dilation
199
Class I of NYHA coincides with which stage of ACCF/AHA stage of HF
A. at risk for HF but without structural HD or symptoms of HF
200
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
< 1 cm2
201
fluid goal in TR
maintain volume/CVP high-normal
| facilitates adequate RV and LV filling
202
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.
Mixed Lesions
203
MR: high SVR consequences
LV decompenstion
- reduce afterload w/ vasodilators (nipride +/- inotropic) to improve LV function
- EXTREME reduction in BP = low CBF, low CO
204
AS always associated w/ some degree of aortic regurge (T/F)
T - almost always
205
Ao: normal valve area
2.5 - 3.5 cm2
206
valvular classificationn (type of lesions) based on 3 things
1. stenosis
2. insufficiency
3. mixed
207
AS: what does LAP do to accomadate LV filling
LAP inc to maintain CO
| - if LVEF is < 40%, CO maintained ONLY with inc LAP (25-30%)
208
LAP > ___ mmHg can cause inc PAP
18
| increases PVR -> RV failure
209
TR: Nitrous implications
weak PA vasoconstrictor
could INC TV regurgitation
--AVOID --
210
MS: preop anxiolytic implications
increases susceptibility to ventilator-depressant effect
211
TR surgery prevalence
rarely done
212
NH on MVP antibiotic prophylaxis in dental procedure
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
MS: narrowed valve; 2 hemodynamic consequences (hint: gradient and flow/LV volume)
1. gradient develops across valve orifice (compensatory change to maintain flow)
2. flow is restricted and LV volume DEC
214
MVP pathophys
myxomatous degeneration of cusps replacing normal fibrous tissue
- leaflets become supple and redundant
- affect chordae tendineae - more pliable and elongated
215
MVP: this population may have CHF, exercise intolerance, orthopnea, DOE, on diuretics/ACEi, midsystolic to holosystolic murmur, S3 gallop and sx of Pulm edema
older men
