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37 Cards in this Set
- Front
- Back
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Indications for surgery for aortic stenosis
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angina, syncope, CHF or resuscitation from episode of sudden death.
Asymptomatic = NO surgery |
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What two types of valves are used to replace aortic valve?
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mechanical or tissue
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What must the LV do to compensate in aortic stenosis?
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Due to pressure overload from stenosed valve, the LV hypertrophies and thus we have reduced ventricular compliance
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What must the LV do to compensate in aortic regurgitation?
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The LV increases its stroke volume to accomodate blood entering from the lungs as well as blood leaking back through the aortic valve
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causes of acute aortic regurgitation
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endocarditis
type A dissection (ascending aortic dissections often involve the aortic valve) |
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symptoms of acute aortic regurgitation
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acute LV failure & pulmonary edema because ventricle unable to dilate acutely and handle volume overload
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symptoms of chronic aortic regurgitation
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produces pressure & volume overload of LV resulting in progressive LV dilatation, increase in wall stress and progressive hypertrophy and syptoms of L sided HF
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causes of mitral stenosis
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rheumatic fever (#1 cause)
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What physiology compensation is seen in mitral stenosis?
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Reduced LV filling causes decreased forward flow and increased L atrial & pulmonary pressures leading to CHF
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Causes of acute mitral regurgitation
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myocardial ischemia or infarction with papillary muscle rupture
endocarditis idiopathic chordal rupture |
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What happens physiologically in mitral regurgitation?
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s/s of CHF (fluid overload back into L atrium) and low CO state (lack of forward flow d/t regurg)
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What is the mostly common valvular disorder?
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Mitral regurgitation
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Indications for surgery of Mitral regurg?
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acute MR with cardiogenic shock/CHF
acute endocarditis with hemo compromise severe MR asymptomatic but EF < 60%, A fib |
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How are mitral valves fixed?
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replacement (papillary rupture) vs. repair
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Causes of tricuspid disease?
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Often secondary to mitral disease. Usually tricuspid regurg, stenosis is rare.
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Ventricular septal defects, if acquired post MI/trauma, will present with what symptoms?
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acute left heart failure, chest pain, low CO and shock
(usually left to right shunt) |
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Causes of aortic aneurysm
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degenerative changes caused by aging or familial predisposition
congenital weakness of aorta HTN pregnancy coarctation of aorta (narrows) Marfan syndrome arterial cannulation (PCI) trauma |
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"False" aortic aneurysm
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does not involve all layers of the artery
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"true" aortic aneurysm
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involves all layers of the arterial wall
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s/s of aortic aneurysm (all types)
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bruit over aorta
normal to high BP |
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s/s of aortic aneurysm (ascending thoracic specifically)
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often asymptomatic
dyspnea CP |
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s/s of aortic aneurysm (aortic arch specifically)
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dyspnea
stridor, cough JVD hoarseness, weak voice |
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What EKG changes will one see in pericarditis?
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Diffuse ST segment elevation in ALL leads except AVL, AVR V1
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_____ % of CABG patients develop post operative a fib
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30%
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Usually, CABG patients with a good pre-op ejection fraction will present with __________ post op
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hypertension post operatively
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Causes of EKG (acute MI) changes in post op CABG:
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coronary spasm
incomplete revascularization poor myocardial protection acute graft closure re-perfusion injury |
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What do we commonly do in response to acute MI EKG changes post op CABG?
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start Nitro! May need repeat cath & IABP, may need reexploration
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How soon should antiplatelet therapy be started post CABG? why important?
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6-24 hrs
inhibits deposits on new vein/artery grafts |
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Why is A-fib very bad in aortic stenosis repair?
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LV relies heavily on atrial kick for CO
Preload dependent |
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In post op Aortic stenosis valve repair keep CVP > _____
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15 (preload dependent)
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Post op AVR, what should BP be kept at?
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Low! often at 90 systolic d/t recent aortotomy
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What commonly happens to SVR in post op aortic regurg patients?
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Sudden increased SV causes carotid sinus to vasodilate, often need alpha support for a bit
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Post aortic regurg repair what type of med is better for BP control: vasodilator or beta blocker?
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beta blocker, SVR will drop post op d/t increase in SV
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Considerations in post operative mitral stenosis repair:
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usually have a small LV cavity, rely a lot of RV for CO.
Often harder to wean on ventilator d/t pulmonary HTN |
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Considerations inpost operative mitral regurg repair:
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Once the valve is competent you may unmask LV dysfunction.
May need prolonged inotropic support and after load reduction with vasodilators. |
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Why are we using Cleviprex more now instead of Nitro for BP control post op?
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because it doesn't effect preload, Nipride wouldn't decrease preload either
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How do you check for acute MI immediate post op?
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compare pre op EKG with post op EKG. Even if anesthesia tells you surgeon is aware of EKG changes, it is a good idea to call it in.
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