Valvular Heart Problems Flashcards
(96 cards)
1
Q
What 3 levels can aortic stenosis occur?
A
- Valvular
- Subvalvular
- Supravalvular
2
Q
What is the most common valvular problem?
A
Aortic stenosis
3
Q
In aortic stenosis, a valvular problem occurs where?
A
Leaflets
4
Q
name the 3 types valvular aortic stenosis.
A
- Calcification and fibrosis of normal valve
- Calcification and fibrosis of congenital bicuspid AV
- Rheumatic
5
Q
What caused the decline in rheumatic aortic stenosis?
A
antibiotics
6
Q
How are the 3 leaflets of the aortic valve named?
A
Coronary artery
7
Q
What is a normal aortic valve opening?
A
2-4 cm²
8
Q
What is opening of a aortic valve with severe stenosis?
A
<1 cm²
9
Q
What is surgical indication for aortic stenosis?
A
<1 cm²
10
Q
What 2 things is the aortic valve between?
A
Left Ventricle and Aorta
11
Q
Normally the aortic valve has how many leaflets?
A
3
12
Q
In a normal Left Ventricle, the mean peak gradient is what?
A
> 50 mmHg
13
Q
What may underestimate the severity of aortic stenosis?
A
Low peak gradient from poor left ventricular function.
14
Q
Chronic LV pressure overload leads to what?
A
Left Ventricle Hypertrophy
15
Q
In aortic stenosis left ventricular hypertrophy is need to do what?
A
Decrease wall stress
16
Q
What 3 problems arise with left ventricular hypertrophy?
A
- ↓ diastolic compliance
- ↓ coronary blood flow
- imbalance of cardiac O2 supply and demand
17
Q
What 2 things does ↓ diastolic compliance lead to?
A
↑ LVEDP
↑ LVEDV
18
Q
Overall the major concern with aortic stenosis is what?
A
Myocardial ischemia
19
Q
Myocardial ischemia in aortic stenosis is related to what 4 things?
A
- LVH
- ↑ wall stress
- ↓ coronary perfusion
- ↓ coronary flow reserve
20
Q
What is the most crucial goal in Aortic Stenosis?
A
Sinus Rhythm
21
Q
In aortic stenosis you must _______ any SVT’s promptly.
A
Cardiovert
22
Q
What is the optimal HR in aortic stenosis?
A
60-80
23
Q
What does tachycardia in artial stenosis lead to?
A
Ischemia & Ectopy
24
Q
What does bradycardia lead to in aortic stenosis?
A
Low CO due to fixed stroke volume.
25
In aortic stenosis Adequate ________ is essential, but difficult to predict due to ________.
Preload
| Diastolic dysfunction
26
In aortic stenosis you need to maintain ________ and avoid _________.
Contractility
| Myocardial depressants
27
In aortic stenosis, hypotension needs to be treated quickly with what 2 things?
Phenylepherine
| Trendelenburg
28
Trendelenburg increases what?
Preload
29
In aortic stenosis what drugs are used to maintain coronary perfusion pressure?
Alpha agents
- Phenylepherine
- Norepinephrine
30
What type of anesthesia should be avoided with aortic stenosis?
Spinal and epidural
31
Why should spinal and epidural anesthesia be avoided in aortic stenosis?
Decrease in preload
| Increase in HR
32
What is the most crucial time in aortic stenosis surgery?
Induction
33
What monitoring in needed for aortic stenosis?
Standard and pre-induction A-line
34
How would you premedicate aortic stenosis patients?
- Young and anxious get Benzos
| - Old and frail get little or no benzos
35
After aortic stenosis bypass a noncompliant heart is dependent on what?
Stable rhythm
36
In weaning aortic stenosis off bypass what would you give for LV dysfunction?
inotropes
37
What is a myomectomy?
surgery to remove the septal muscle of enlarged heart
38
How would you treat a subaortic or cavitary obstruction after a aortic valve replacement?
Volume
Beta blockers
Myomectomy
39
Name 3 types of aortic regurge.
- Aortic root dilation
- Deformed cusps
- Cusp Prolapse
40
Name the 7 causes of aortic root dialtion w/ aortic regurge.
- HTN
- Aortic dissection
- Cystic necrosis
- Marfans
- Syphilitic
- Ankylosing spondylitis
- Osteogensis imperfecta
41
Name 3 things which cause deformed cusps in aortic regurge.
- Rheumatic
- Infective endocarditis
- Bicuspid valve
42
What typically causes aortic regurge cusp prolapse?
Aortic dissection
43
Regurge are considered what type of problems?
Volume
44
Stenotic are considered what type of problem?
Pressure
45
T/F aortic regurge is symptomatic?
F-Asymptomatic
46
In aortic regurge, how does the LV maintain systolic function?
- Dilation
| - ↑ compliance
47
What is the main problem with aortic regurge?
LV volume and pressure overload
48
In the latter stage of aortic regurge, the LV decompensates and what happens?
- CHF
- Arrhythmias
- Sudden death
49
T/F aortic regurge develops concentric hypertrophy.
F- Eccentric Hypertrophy
50
What is the problem w/ acute aortic regurge?
LV can not compensate (dilate) quickly enough.
51
What does acute aortic regurge lead to?
Pulmonary edema
52
What is needed with acute aortic regurge?
emergency surgery
53
What is t he optimal HR for aortic regurge?
90
54
Why should you avoid bradycardia with aortic regurge?
-↑ regurgitation
55
Why do you need to avoid afterload with aortic regurge?
-Pressure gradient
56
What meds are needed for aortic regurge?
- inotropes
| - Vasodilator (nipride)
57
What is contraindicated in aortic regurge?
Balloon pump
58
What anesthetic technique can be useful in aortic regurge if LV is impaired?
Narcotic based
59
Why would ketamine be used in acute aortic regurge?
maintain HR
60
```
Pressure = __________
Volume = ___________
```
Hypertrophy
| Dilation
61
What usually causes mitral stenosis?
Rheumatic
62
What happens to the mitral valves leaflets during stenosis?
- Thickening
- Calcification
- Fusion
63
What are the surgical indications for mitral stenosis?
- Opening <1cm²
- NYHA class 3/4
- Left atrium clot
64
In mitral stenosis, what is the main problem?
-Pressure gradient between LA and LV.
65
In mitral stenosis, ↑ left atrial pressure causes what?
- Pulmonary HTN
| - Left atrial enlargment
66
Left atrial enlargement causes what?
Afib
67
Pulmonary HTN causes what?
- Right ventricular dysfunction and enlargment
| - Tricuspid regurge
68
What are the 3 hemodynamic goals of Mitral Stenosis?
- Preserve Sinus Rythm
- Avoid Tachycardia
- Avoid worsening pulmonary HTN
69
What 5 things should you avoid with pulmonary HTN?
- Hypercarbia
- Acidosis
- Hypothermia
- Sympathetic activation
- Hypoxia
70
Why does hypercarbia and acidosis worsen pulmonary HTN?
Constricts pulmonary arteries
71
Anesthetic management of Mitral stenosis.
- Benzos (HR)
- O2 (pulmonary HTN)
- Control HR
72
in mitral stenosis PA pressures can be ___________ due to LVEDP and LVEDV
Underestimated
73
What is the most effective drug with Mitral Stenosis
Esmolol
- 10-20 mg bolus
- 50-100 mcg/kg/hr
74
What 2 meds should be avoided with mitral stenosis and why?
- N2O (pulm HTN)
| - Panc (tachy)
75
What drugs should be used if preop pulm HTN or RV dysfunction in mitral stenosis?
Milrinone
| Nitric Oxide
76
4 causes of mitral regurge
- Myxomatous degeneration
- Ischemia
- Endocarditis
- Trauma
77
Mitral regurge is ________ overload of the _________.
Volume
| LV
78
LV overload in mitral regurge leads to what?
-Massive LA dilation w/ arrhythmias.
79
When Mitral regurge valve is repaired, what do you need to be aware of?
LV dysfunction is unmasked. Flow now going forward, heart not used to pumping that hard.
80
Severity of mitral regurge is based on what?
- Pressure gradient LA - LV
- Size of regurge orifice (ERO)
- Duration of systole
81
When is pressure gradient between LA and LV lowest in mitral regurge?
Early in the disease, before LA expands to handle more volume
82
3 goals in mitral regurg.
- Vasodilators
- High HR
- Maintain contractility
83
How do vasodilators help mitral regurge?
- ↓ afterload
- ↓ regurge fraction
- ↑ forward flow
84
Why might inotropes and vasodilators be needed after mitral regurge valve surgery?
- Lessen afterload
| - Improve forward flow
85
Why is MV repair beneficial to MV replacement?
- Preserve papllary and chordae
| - Enhanced LV function
86
Primary Causes for tricuspid regurge?
- Rheumatic
- Carcinoid
- Ebstein's
- Trauma
- Endocarditis
87
Secondary causes of tricuspid regurge?
- Chronic RV dilation
| - Mitral valve disease
88
It is very rare to see a tricuspid valve problem w/o ________ valve problem.
Mitral
89
Right atrial pressure rise only with end stage disease why?
RA is very compliant
90
What worsens tricuspid regurge?
Pulm HTN due to mitral vale disease increases right ventricle afterload.
91
What cause paradoxical motion of the LV septum?
Right ventricle enlargement
92
What problems arise from LV pradoxical movement?
Impaired LV filling and compliance
93
Right heart failure causes what?
Hepatomegaly and ascites
94
How do you treat tricuspid regurge?
- treat mitral valve problem
- Avoid pulm HTN and PVR
- Normal to high preload
95
WHY avoid beta blockers with tricuspid regurge?
Worsen pulm HTN
96
What monitor may be difficult to place with tricuspid regurge?
PAC (swan)
