Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Assessment > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

Test 2 (71 cards)

Start Studying
1
Q

The most worrisome valve disease is ________

A

Aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

__________ produces pressure overload and ___________ produces volume overload

A

Stenosis

Regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

50% of pt with aortic stenosis over the age of 50 years old have ________

A

IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

_______ pts with mitral or aortic valve disease worsen the prognosis

A

CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What could be a presenting symptom in someone with severe aortic stenosis?

A

Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are compensatory mechanisms with valve diseases?

A

Increased SNS
Myocardial hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the NY Heart Association Functional Heart Disease table evaluate? Describe the classes.

A

It evaluated exercise tolerance and cardiac reserve

Class I: asymptomatic

Class II: Symptomatic with regular activity but comfortable at rest

Class III: Symptomatic with minimal activity but comfortable at rest

Class IV: Symptomatic at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mitrial stenosis/regrugitation may present with what type of rhythm on the EKG?

A

Atrial rhythms –> A fib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

_________ is common to see in valve diseases

A

Angina pectoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HF can produce a ____ heart sound

A

3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F: elective surgery is deferred until CHF can be treated and myocardial contraction is optimized

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes murmurs?

A

Turbulent blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes systolic murmurs?

A

Aortic/Pulmonic stenosis

Mitral/tricuspid regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes diastolic murmurs?

A

Aortic/Pulmonic regurgitation

Mitral/tricuspid stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which type of murmurs are more worrisome?

A

systolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Aortic stenosis has a __________ murmur and has a ________ sound pattern

A

Midsystolic

Crescendo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where is a midsystolic murmur best heard at? What does this indicate?

A

R upper sternal border

Aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Mitral regurgitation has a _________ murmur. Where is this best heard at? Where does it radiate to?

A

Holosystolic

At the apex

Axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the auscultation sites?

A

Aortic: 2nd ICS RSB

P: 2nd ICS LSB

T: 5th ICS LSB

M: 5th ICS MCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What additional EKG changes might you see with valve diseases?

A

Broad, notched P waves –> L atrial enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What CXR findings might indicate valve disease?

A

Cardiomegaly
L mainstem bronchus elevation
Valvular calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Cardiomegaly?

A

Cardiac sillouette is >50% of thorax from rib to rib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the tests used to Dx valve diseases?

A

EKG
CXR
ECHO
Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Whats the major difference between angiography and ECHO with valve diseases?

A

Angiography is able to tell you the flow through the coronaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What type of ECHO would you use to detect thrombus?
TEE
26
How long do Mechanical valves last? Bioprosthetic?
Mechanical: 20-30 years Bioprosthetic: 10-15 years
27
Mechanical heart valves can be made of _______
Metal or Carbon alloy **Think MRI**
28
T/F: Warfarin is given up until the 3rd trimester in pregnancy
F Warfarin is associated with fetal defects/death
29
What is normal protocol for warfarin in pts with prosthetic valves who need Sx?
If minor Sx w minimal blood loss: continue If major Sx: d/c 3-5 days preop and bridge with heparin until the day before or day of Sx. --> restart heparin postop
30
Mitral stenosis is associated with what disease? What are s/s of this?
Rheumatic heart disease: unDx childhood fever -vision changes
31
Mitral stenosis primarily affects ________
women
32
T/F: Mitral stensosis can be asymptomatic for 20-30 years
T
33
What is the normal size of a mitral valve? What is the size that symtpoms develop?
Normal: 4 - 6 cm2 Symptoms: < 2 cm2
34
What are s/s of mitral stenosis?
**pulmonary symptoms** Dyspnea on exertion -orthopnea -paroxysmal nocturnal dyspnea -pulmonary edema -pulmonary HTN **A-FIB**
35
In mitral stenosis, what happens with the L ventricle?
L ventricle function is preserved
36
What is the Tx for mitral stenosis?
Rate control: BB, CCB, Digoxin Diuretics Anticoags Sx
37
What are anesthesia considerations for mitral stenosis?
Goal: Keep normal hemodynamics -dont fluid overload/tredelenburg -avoid tachycardia (epi, ephedrine, gylcoprrolate, ketamine) -BP/SVR: Neo/vaso - avoid pulm HTN --> no hypoventilation, hypercarbia, hypoxemia (induction/emergence) -Treat diuretic complications --> low K+, orthostatic hypotension
38
What reversal do we use with mitral stenosis?
Sugamadex
39
What NMB do we avoid in mitral stenosis? Why?
Pancuronium Atracurium They release histamine causing increase in HR
40
Mitral ______ is more common than mitral _______
regurgitation stenosis
41
What is mitral regurgitation commly associated with?
IHD Ruptured papillary muscle Endocarditis Mitral valve prolapse Cardiomyopathy **Direct cardiac trauma**
42
mitral regurgitation decreases what 3 things?
forward LV flow SV CO
43
mitral regurgitation is associated with _______ hypertrophy. What does this mean?
eccentric LV is larger and more compliant --> able to deliver a larger stroke volume
44
What are mitral regurgitation Tx?
Repair or replacement Transcathether mitral valve repair (MitraClip) Vasodilators (ACE-I, BB) Biventricular pacing
45
What is the prefered BB used in mitral regurgitation?
Carvedilol
46
T/F: With mitral regurgitation, there is great improvement with Sx if EF < 30%
F There is little improvement with Sx
47
What do we want to avoid in mitral regurgitation? Why?
Bradycardia and increasing SVR **Want a normal to slightly increased HR** --> To prevent decreased CO Avoid increasing SVR --> will cause increased backflow **Avoid phenylephrine**
48
Why is Neuraxial anesthesia good for mitral regurgitation?
Causes vasodilation which allows for better forward flow
49
__________ decreases SVR and increases __________ in mitral regurgitation. What is an example of this medication?
vasodilators forward flow Nitroprusside
50
Aortic stenosis can ALSO be dt _________. When does this develop?
buscupid aortic valve Early in life compared w/ tricuspid
51
Aortic stenosis is associated with increased ________
mortality
52
What is the normal aorta valve area? What is the severe aortic stenosis area?
Normal: 2.5 - 3.5 cm2 Symptomatic: < 1 cm2
53
Aortic stenosis results in __________ hypertrophy. What does this mean?
Concentric LV is less compliant. Contractility is decreased. SV is decreased
54
What are the symptoms that correlate with average time of death in Aortic stenosis?
Angina pectoris = 5 years Syncope = 3 years dsypnea on exertion = 2 years
55
What can you possible see on the CXR w Aortic stenosis?
Prominent ascending aorta Aortix aneurysm
56
What EKG changes would you see in Aortic stenosis?
ST depression T wave inversion
57
WHat is signicant regarding Aortic stenosis and stress tests?
Generally dont tolerate exercise stress test --> have to do chemical/nuclear
58
What is Tx for Aortic stenosis?
If symptomatic: Ballon valvotomy -Transcatheter aortic valve replacement (TAVR)
59
What are the factors that must be met for Transcatheter aortic valve replacement (TAVR)?
> 65 yo transfemoral TAVR is feasible Aortic valve must be trileaflet No high risk anatomy
60
Asymptomatic aortic stenosis has a risk of what?
sudden death
61
What are the anesthesia considerations in aortic stenosis?
Maintain NSR Optimize intravascular fluid volume Aggressive tx of hypotension GA > Epidural/spinal (Use etomidate/fentanyl) ------------------- Put in A-line for gradual induction Consider not NPO for 8 hours for fluid volume For low BP --> Neo Tachy --> BB: esmolol Brady --> ephedrine, atropine, glycopyrrolate
62
T/F: CPR is trypically not effective in aortic stenosis
T **Need to prevent them from getting to this point!!!**
63
What causes aortic regurgitation?
Endocarditis -rheumatic fever -bicuspid aortic valve -anorexigenic drugs (meth & phentermine) -aortic dissection
64
aortic regurgitation has a ______ onset. Why is this relevant?
Slow they can compensate well
65
aortic regurgitation is associated with _________ hypertrophy.
eccentric
66
In aortic regurgitation, SV _______ and EF _________
increases decreases
67
What are s/s of aortic regurgitation?
Widened PP Bounding pulses
68
Another name for the aortic regurgitation murmur is the ___________
Austin-Flint murmur
69
How do you treat aortic regurgitation?
**decrease systolic HTN, LV wall stress, and improve LV function** Diuretics ACE-I CCB Sx -AVR -aortic root replacement
70
What are the anesthesia considerations with aortic regurgitation?
avoid bradycardia -want HR 80-100 avoid increase in SVR use vasodilators to decrease afterload --> nitroglycerin/nitroprusside use inotropes --> milrinone
71
What type of anesthesia do you want to use withaortic regurgitation?
GA inhaled or IV Use NMBD with minimal or no effect on BP Keep full volume normal and adequate preload

Assessment (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions