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