Valvular Disease Anesthesia

Front 1

which valvular disease/es is associated with a "pressure overload"?

Back 1

aortic stenosis

Front 2

which valvular disease/es is associated with a "volume overload"?

Back 2

aortic and mitral regurge

Front 3

which valvular disease/es is associated with "volume and pressure underload"?

Back 3

mitral stenosis

Front 4

name 6 compensatory mechanisms and secondary problems associated with valvular disease?

Back 4

chamber enlargement, hypertrophy, changes in sympathetic activity, altered LV compliance, myocardial ischemia and chronic dysrhythmias

Front 5

how does TEE work? The beam is adjusted so that it is _______to the cardiac structure of interest. The image displayed is based on ______ and _____ of reflected signals

Back 5

transmits high-frequecy sound waves that are reflected from the cardiac structures encountred; perpendicular; amplitude, time delay

Front 6

what are 6 contraindications to TEE?

Back 6

esophageal stricture, esophageal masses, recent bleeding from esophageal varices, zencker diverticulum, s/p radiation to neck, recent gastric bypass surgery

Front 7

which TEE view visualizes the left ventricle from the direction of stomach and evaluates ventricular performance?

Back 7

transgastric short axis view

Front 8

which TEE view would you use to evaluate calcification of the aorta?

Back 8

ascending aorta short axis view

Front 9

which TEE view is best for assessing clot formation?

Back 9

left atrial appendage view

Front 10

what TEE view is important to assess before cannulating the aorta?

Back 10

ascending aorta short axis

Front 11

which type of valve replacement is the best choice for an elderly person who cant take blood thinners? Which type is best for a young patient?

Back 11

bioprosthetic (porcin or bovine); mechanical (metal or carbon alloy)

Front 12

which type of valve has the lowest thrombogenic potential?

Back 12

bioprosthetic

Front 13

what is the most common cause of mitral stenosis?

Back 13

rheumatic heart dz.

Front 14

The onset of mitral stenosis typically occurs very _____. MItral stenosis is associated with what 3 complications?

Back 14

slowly; CHF, pulmonary htn, RV failure

Front 15

name 5 symptoms of MS. These symptoms are related to ______ left atrial pressures

Back 15

DOE, Orthopnea, PND, Left atrial enlargement on CXR, Borad notched P-waves; high;

Front 16

what is considered "critical" mitral stenosis?

Back 16

MV area < 1.5 cm2 (normal = 4-6)

Front 17

what is the goal in mgt of patients with MS?

Back 17

prevent/treat pulmonary edema or decreases in CO (avoid tachycardia, prompt txt of arrhythmias, avoid trendelendburg position, avoid fluid overload); avoid tachycardia (anti-cholinergics, histamine releasing NMB, ketamine, and have esmolol handy); avoid hypoventilation/resp acidosis (care with anti-anxiety meds, avoid increases in PVR)

Front 18

which valvular disease is really difficult on pregnant women?

Back 18

MS

Front 19

is it okay to use neuraxial anesthesia on a MS pt?

Back 19

yes but only if they are not anti-coagulated

Front 20

what is an absolute contraindication for IABP?

Back 20

AI

Front 21

what valvular disease process is associated with rheumatic fever?

Back 21

MS

Front 22

what type of murmur is associated with mitral stenosis? What type of filling abnormalities present with mitral stenosis?

Back 22

mid diastolic murmur; decreased EDV and ESV

Front 23

positioning for robotic procedures would be least tolerated by what valve dz?

Back 23

mitral stenosis

Front 24

Vasopressor of choice for MS?

Back 24

Neo

Front 25

what type of murmur is associated with MR/MI? What might be seen on the pulmonary artery waveform and ECG?

Back 25

holosystolic murmur; increased v-wave and LVH on ECG

Front 26

filling pattern associated with MR/MI?

Back 26

increased LVEDV

Front 27

name some of the causes associated with MR

Back 27

endocarditis, MVP, LVH, papillary muscle dysfunction, SLE, Rheumatoid arthritis, Ankylosing spondylitis, Carcinoid syndrome

Front 28

the left atria become more compliant, the left ventricle gradually enlarges, and there is an overall decreased forward left ventricular stroke volume in what type of valve dz?

Back 28

mitral regurge

Front 29

treatment of MR?

Back 29

early replacement (before EF<30% or LVESD >55mmHg)

Front 30

should treatment of symptomatic MR be considered an emergency if EF is normal?

Back 30

yes

Front 31

what is the ideal form of treatment for MR, replacement or repair of the valve?

Back 31

repair preferred to maintain normal ejection anatomy

Front 32

what are the anestheia goals for MR?

Back 32

Forward, Fast, Full (forward pressure, fast HR, full volume) 1. prevent and treat decreased CO 2. improve forward LV stroke volume 3. Maintenance of normal to slightly high HR 4. afterload reduction

Front 33

anesthetic choices for pt with MR?

Back 33

avoid excessive narcotic-induced bradycardia, volatile agents are a GOOD CHOICE to decrease SVR, maintain adequate volume, neuraxial techniques are a GOOD CHOICE to decrease afterload

Front 34

which valve dz is associated with increased age, htn, and hlp? Why would this disease occur if they are younger (30-50yrs)?

Back 34

AS; if bicuspid

Front 35

what is considered severe AS?

Back 35

<0.8cm2 (normal 2.5-3.5)

Front 36

which valve dz is associated with increased myocardial O2 demand and decreased supply?

Back 36

AS

Front 37

name 3 symptoms associated with AS; what is the 3-year mortality rate if they have all 3 symptoms?

Back 37

angina, syncope, DOE; 75%

Front 38

anesthesia goals for pt with AS?

Back 38

maintain NSR, maintain normal systemic pressure, maintain fluid volume

Front 39

induction/maintenance of anesthesia with the AS pt?

Back 39

avoid neuraxial!; do not decrease SVR, treat hypotension with alpha agonists, prompt treatment of brady or tachy dysrhthymias, pulmonary artery catheters are useful

Front 40

which type of arrhythmia is most likely to occur in AS? MS?

Back 40

ventricular arrhythmias; atrial arrhythmias

Front 41

what is your vasopressor of choice for treatment of hypotension in AS?

Back 41

Neo

Front 42

what is your vasopressor of choice for treatment of AR?

Back 42

Ephedrine

Front 43

what type of anesthetic agents would be ideal for induction with the AS pt? Which induction agent should be avoided?

Back 43

benzos, narcotic, etomidate; avoid ketamine

Front 44

name 6 possible causes of AR

Back 44

endocarditis, Rheumatic fever, bicuspid aortic valve, aortic dissection, marfan's syndrome, anorexigenic drugs (wt loss drugs)

Front 45

the amount of regurge that occurs in AR is dependent on the ____ and _____-

Back 45

HR and SVR

Front 46

what is the mortality associated with valve replacement for AR?

Back 46

0.2% asymptomatic and 10% symptomatic

Front 47

name 5 symptoms associated with the diagnosis of AR

Back 47

widened pulse pressure; LV dysfunction (fatigue, dyspnea, orthopnea), coronary ischemia, LVH on ECG, abnormal echo

Front 48

what are the 3 anesthesia goals for AR?

Back 48

maintain forward, LV stroke volume (HR 80ish), prevent abrupt increases in SVR (vasodilator/inotropic support); maintain contractility

Front 49

what type of induction/maintenance of anesthesia should be used for pt with AR

Back 49

prevent extreme bradycardia (probably dont use high narcotics), volatile anesthetics are GOOD CHOICES, maintain fluid volume to support preload

Front 50

Do we need to hold anticoagulants for minor surgery in a pt with mechanical valve? what is the process for major surgery?

Back 50

not for minor surgery; hold coumadin for 3-5 days and lovenox instituted with heparin post op until INR is therapeutic

Front 51

What TEE view is this?

Back 51

ascending aorta short axis view

Front 52

What TEE view is this?

Back 52

Left atrial appendage

Front 53

What TEE view is this?

Back 53

4 chamber view

Front 54

What TEE view is this?

Back 54

Aortic valve short axis view

Front 55

What TEE view is this?

Back 55

Transgastric short axis view