Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
MV disease causes?
|
degenerative ( age-associated), inherited, due to ischemic heart disease, myxomatous degeneration, rheumatic dz
|
|
|
Anatomy of MV?
|
posterior leaflet: P1 ( lateral), P2, P3 ( medial)
Anterior leaflet : A1 (lateral), A2, A3 ( medial) |
|
|
Normal MV area?
|
4-5 cm2
|
|
|
symptoms w/ excercise occur at how many centimeters?
Symptoms at rest occur at how many? |
Exercise - 2.5 cm2
Rest 1.5 |
|
|
Effect of MS on LA?
|
hyperthrophy, dilation, increased pressures, fibrillation, clot formation, increased risk of stroke
|
|
|
Effect of MS on pulmonary artery?
|
Increased presure , PA vasoconstriction or medial and intimal hypertrophy
|
|
|
what does the pressure volume loop look like for MS?
|
shifted to the left, LVEDP and LV end-diastolic volume is lower. stroke volume is diminished.
|
|
|
Anesthetic management of MS?
- heart rate ? |
tachycardia poorly tolerated because of he decreased time for diastolic filling. Keep heart rate normal.
|
|
|
Effect of MS on pulmonary artery?
|
Increased presure , PA vasoconstriction or medial and intimal hypertrophy
|
|
|
Anesthetic management of MS
- contractility? |
usually contractility is preserved,
|
|
|
Effect of MS on RV?
|
dilation, hyperthrophy, chronic failure
|
|
|
what does the pressure volume loop look like for MS?
|
shifted to the left, LVEDP and LV end-diastolic volume is lower. stroke volume is diminished.
|
|
|
Anesthetic management of MS
- preload? |
Adequate preload improves forward flow in stenotic lesions, however, in severe MS it may further exacerbate pulmonary congestion and RV failure... careful fluid management advised
|
|
|
Inotropic support choice for MS?
|
Epi and milrinone
|
|
|
Causes for MR?
|
myxomatous degeneration, ischemic heart disease
|
|
|
LV function and EF in chronic MR?
|
LV function is normal
EF usually supranormal or normal |
|
|
which wave on PA trace is abnormal?
|
v
|
|
|
Effect of chronic MR on LV and LA?
|
LV - chronic eccentric hyperthrophy
LA- enlargement |
|
|
Anesthetic management of MR?
- HR? |
High-normal ( 80-100)
bradycardia increases the uration of systolic period and increases diastole ( regurgitation) |
|
|
Anesthetic management of MR?
- preload? |
judicious, pre-induction may help, but can also distend LA and worsen regurgitation.
|
|
|
Anesthetic management of MR?
- contractility |
EF does not correlate w/ actual EF
- systolic dysfunction may be underestimated in chronic severe MR - support w/ volume and pressors |
|
|
How to manage hypotension in patients w/ MR?
|
maintain high normal heart rate
volume ( may need preload) Vasopressor of choice is dobutamine, low dose epi, milrinone |
|
|
Anesthetic management in patients w/ MR
- afterload? |
lower SVR so forward cardiac output is maximized. use adequate anesthetic depth, systemic asodilaors, inodilators and IABP?
|
|
|
Factors that worsen PVR?
|
hypoxia
hypercarbia hypothermia acidosis |
