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24 Cards in this Set
- Front
- Back
MV disease causes?
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degenerative ( age-associated), inherited, due to ischemic heart disease, myxomatous degeneration, rheumatic dz
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Anatomy of MV?
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posterior leaflet: P1 ( lateral), P2, P3 ( medial)
Anterior leaflet : A1 (lateral), A2, A3 ( medial) |
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Normal MV area?
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4-5 cm2
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symptoms w/ excercise occur at how many centimeters?
Symptoms at rest occur at how many? |
Exercise - 2.5 cm2
Rest 1.5 |
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Effect of MS on LA?
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hyperthrophy, dilation, increased pressures, fibrillation, clot formation, increased risk of stroke
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Effect of MS on pulmonary artery?
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Increased presure , PA vasoconstriction or medial and intimal hypertrophy
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what does the pressure volume loop look like for MS?
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shifted to the left, LVEDP and LV end-diastolic volume is lower. stroke volume is diminished.
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Anesthetic management of MS?
- heart rate ? |
tachycardia poorly tolerated because of he decreased time for diastolic filling. Keep heart rate normal.
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Effect of MS on pulmonary artery?
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Increased presure , PA vasoconstriction or medial and intimal hypertrophy
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Anesthetic management of MS
- contractility? |
usually contractility is preserved,
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Effect of MS on RV?
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dilation, hyperthrophy, chronic failure
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what does the pressure volume loop look like for MS?
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shifted to the left, LVEDP and LV end-diastolic volume is lower. stroke volume is diminished.
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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
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Inotropic support choice for MS?
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Epi and milrinone
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Causes for MR?
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myxomatous degeneration, ischemic heart disease
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LV function and EF in chronic MR?
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LV function is normal
EF usually supranormal or normal |
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which wave on PA trace is abnormal?
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v
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Effect of chronic MR on LV and LA?
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LV - chronic eccentric hyperthrophy
LA- enlargement |
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Anesthetic management of MR?
- HR? |
High-normal ( 80-100)
bradycardia increases the uration of systolic period and increases diastole ( regurgitation) |
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Anesthetic management of MR?
- preload? |
judicious, pre-induction may help, but can also distend LA and worsen regurgitation.
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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 |
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How to manage hypotension in patients w/ MR?
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maintain high normal heart rate
volume ( may need preload) Vasopressor of choice is dobutamine, low dose epi, milrinone |
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Anesthetic management in patients w/ MR
- afterload? |
lower SVR so forward cardiac output is maximized. use adequate anesthetic depth, systemic asodilaors, inodilators and IABP?
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Factors that worsen PVR?
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hypoxia
hypercarbia hypothermia acidosis |