Valvular Heart Disease Flashcards
Exam 2 content (41 cards)
How common is valvular heart disease in the US? What is the risk of coexisting IHD?
2.5%
50% of patient with aortic stenosis > 50 years old have IHD
What are a few common comorbidities with valvular heart disease?
HF, afib, angina
What is the New York Heart Association Functional Classification of Patients with Heart Disease? 4 classes and descriptions…
I: asymptomatic
II: symptoms w/ ordinary activity, comfortable at rest
III: symptoms w/ minimal activity, comfortable at rest
IV: symptoms at rest
What are some signs and symptoms of HF?
basilar rales, JVD, 3rd HS, orthopnea, dyspnea, fatigue
If you hear a systolic murmur, what should you be most worried about? What other valvular issues are associated with systolic murmurs?
Aortic stenosis. Pulmonic stenosis. Incompetent mitral or tricuspid valves.
What valvular issues are associated with diastolic murmurs?
mitral stenosis, tricuspid stenosis. Also incompetent aortic and pulmonic valves.
What is a midsystolic murmur and what is it heard with?
occurs between S1 and S2. If heard at the right sternal border and radiates to carotids–> aortic stenosis
What is a holosystolic murmur and what is it normally heard with?
Merged S1 and S2, best heard at the apex of the heart and radiates to axilla–> mitral regurg
When do you hear diastolic murmurs?
These follow S2
Where can you auscultate aortic valve?
R sternal border, 2nd ICS
Where can you auscultate the pulmonic valve?
L sternal border, 2nd ICS
Where can you auscultate the tricuspid valve?
L sternal border, 5th ICS
Where can you auscultate the mitral valve?
5th ICS at the midclavicular line
What diagnostic tools can you use to see valvular disease?
EKG –> not very specific
CXR –> cardiomegaly and calcifications
Echo –> the best diagnostic tool
Angiography –> the most specific test
What are mechanical valves made of, how long do they last, cons?
Made of metal or carbon alloy
Very durable! Lasts 20-30 years–> good for younger patients
Highly thrombogenic–> require long-term AC
What are bioprosthetic valves made of, how long do they last?
These are porcine or bovine.
Shorter lasting 10-15 years –> good for elderly patients
Low thrombogenic potential
When do you typically DC warfarin prior to surgery if your patient has a mechanical valve?
3-5 days prior to surgery (consult with cardiologist) bridge to heparin or LMWH
What is the more rare valvular disease in the US? What typically causes it?
Mitral stenosis is pretty rare in the US. Typically caused by rheumatic heart disease. More common in women, and may be asymptomatic for 20-30 years
What dysrhythmia is commonly associated with pulmonary complications?
afib or paroxysmal afib
Treatment options for mitral stenosis?
rate control (BBs, CCBs)
diuretics
anticoagulation
valve replacement with more severe disease
What are anesthesia concerns related to mitral stenosis?
maintain normal HR (avoid ephedrine) and volume. Avoid excessive pre-op fluids (albumin may be a good option), caution with Trendelenburg positioning. Cardiovert afib w/ RVR. Avoid NDMBs that release histamines like cis. Use caution with neuraxial anesthesia. Treat hypotension.
What conditions is mitral regurgitation most commonly associated with?
IHD, endocarditis, mitral valve prolapse, cardiomyopathy
What are treatment options for mitral regurg?
MV repair (transcatheter mitraclip) or MV replacement. Biventricular pacing, ACEi or BBs.
What are some anesthesia concerns with mitral regurgitation?
avoid bradycardia and anything that would decrease CO. Avoid phenylephrine and increasing SVR. Neuraxial anesthesia tends to be well tolerated. Ketamine = good (increased HR).
