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48 Cards in this Set

  • Front
  • Back
For pts with prosthetic heart valves, they may have to discontinue ____ prior to surgery, and carry a greater risk of ___ and ____.
anticoagulation, thromboembolism and bacterial endocarditis
In ______, which is commonly caused by rheumatic heart disease, the ____ is not affected.
mitral stenosis, LV not affected
In mitral stenosis, _____ growing on valves makes them immobile/fixed, leading to poor ____ because there is only a pinhole for the L atria to flow into the LV. This results in _____ enlargement.
calcium, poor opening, L atrial enlargement
In mitral stenosis, there is a mechanical obstruction to ____ filling. This leads to incr ____ volume and pressure, with a subsequent pressure overload of the R ventricle. Mitral stenosis may then progress to _____.
LV filling, incr L atrial vol and pres., pulmonary edema
Mitral stenosis is treated with diuretics because ...
excess volume can end up in pulmonary circulation
Mitral stenosis requires good control of afib because...
you need a good atrial kick to prevent congestion
It is important to control _____ and provide _____ in mitral stenosis.
control HR, provide anticoagulation
The goal HR in valvular disease is
70
What are the anesthetic techniques for pts w mitral stenosis?
- avoid ketamine (tachycardia, heart filling occurs at expense of diastole, less filling when tachy)
- maintain HR control
- avoid vol overload (tberg can cause pulm edema)
- avoid incr pulm vascular resistance (hypercarbia and hypoxia)
Hypercarbia and hypoxia both cause this vascular change in the lungs
pulmonary vasoconstriction
Mitral regurgiation is (more/less) amenable to surgery than mitral stenosis.
less
The _____ support leaflets from opening inappropriately.
chordae
Mitral regurg is a ____ valvular disease with ruptured ______, caused by....
ischemic, ruptured chordae

caused by endocarditis, cardiomyopathy, rheumatic illness
Mitral regurgitation leads to ______ stroke volume and C.O.
decreased
Mitral regurgitation is associated with ____ overload of the LV.
volume overload
What effect does mitral regurgitation have on the L atrium?
L atrial enlargement and afib -- dilation interrupts conductivity
When L atrial enlargement can no longer compensate for mitral regurgitation, _____ ensues.
pulmonary edema
The regurgitant fraction in mitral regurg is affected by...
heart rate and pressure gradient across mitral valve.
>0.6 is considered significant regurg
What are the diagnostic criteria for mitral regurgitation?
- holosystolic apical murmur radiating to axilla
- LVH and cardiomegaly on CXR
- echocardiogram
What are the anesthesia strategies indicated for mitral regurgitation?
- prevent bradycardia
- prevent incr SVR
- minimize myocardial depr
maintenance of fluid volume is importantt for maintaining LV volume and CO
This is the most common type of valvular disease, affecting ___ % of the population.
mitral valve prolapse, 1-2.5%
What are the auscultatory sounds of mitral valve prolapse?
midsystolic click, late systolic murmur
What diseases are associated with mitral valve prolapse?
- marfan's syndrome
- SLE
- thyrotoxicosis
- rheumatic carditis
Mitral valve prolapse is usually benign, but could cause...
- embolism
- dysrhythmia
-death
Do mitral valve prolapse pts require abx prophylaxis?
- if regurg present
What is the management of mitral valve prolapse
-same as for mitral regurg
-prevent brady, prevent increases in SVR, min myocardial depression, maintain IVF)
____ is a calcification of aortic leaflets during aging, or the presence of a bicuspid aortic valve.
aortic stenosis
In aortic stenosis, obstruction of LV output leads to ______.
LV pressure overload (pinhole opening at aortic valve between LV and aorta)
In aortic stenosis, the LV tries to compensate with...
concentric LV hypertrophy (hypertrophy will result with any fixed mechanical obstruction)
What are the classic symtpoms of aortic stenosis?
angina, syncope, dyspnea on exertion
What are the diagnostic criteria for severe aortic stenosis?
- transvalvular gradient 50 mmHg
- peak pressure gradient 80 mmHg
- aortic valve area less than 0.8 cm^2
In managing aortic stenosis during anesthesia, there exists a high risk of major perioperative ____ complications. Therefore, it is important to maintain _____ because _____ is very important to function.
cardiac complications, maintain sinus rhythm, atrial kick is very important
What is the ideal HR for aortic stenosis pts during anesthesia?
70! avoid brady/tachycardia
-avoid hypotension
Why is it crucial to avoid hypotension in aortic stenosis pts?
hypertrophied hearts are harder to perfuse, loss of preload leads to decr CO
If you need to restore BP and contractility during a case in a pt w aortic stenosis, it is important not to use...
ephedrine or phenylephrine! use epinephrine instead to restore BP and incr contractility, because you need a kick and a squeeze
In aortic stenosis it is important to avoid hypovolemia so that you can maintain adequate ____.
preload
___ is the failure of the aortic valve leaflet's coaptation (closing) due to primary valve disease.
aortic regurgitation
What are the causes of aortic regurgitation?
- endocarditis
- rheumatic fever
- bicuspid aortic valve
Aortic regurgitation may result from abnormalities of the aortic root, as in the following conditions....
idiopathic, HTN, syphilis, connective tissue disorder, ankylosing spondylitis
Aortic regurg leads to a decr in CO due to
flow back into the LV during diastole
Aortic regurg leads to ___ and ___ overload of the LV.
pressure and volume
The regurgitant fraction in aortic regurgitation is affected by ...
HR and pressure gradient across the aortic valve
Over time, aortic regurg causes the ____ to fail and ____ develops.
LV fails, Pulm edema
In acute aortic regurg, ____ and ___ may occur quickly.
coronary ischemia, CHF
What are the 2 primary mgmt techniques for pt with aortic regurg?
- vasodilator therapy
- valve replacement
What are the anesthesia strategies for a pt with aortic regurg?
- maintain forward stroke volume
- keep HR above 80
- avoid incr in SVR
- minimze myocardial depr
*FAST, FORWARD AND FULL*
What are the causes of tricuspid regurg?
- annular dilation due to RV enlargement or pulm HTN
- endocarditis
- rheumatic heart disease
What are the anesthesia strategies for a pt in tricuspid regurg?
- maintain preload
- beware of R to L shunting across PFO, high R atrial pressures lead to shunting to L heart without traveling first through lungs -- leads to hypoxia