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37 Cards in this Set

  • Front
  • Back
Comparison of Normal ventricle sizes
Left ventricle 3x greater than right ventricle b/c has to overcome SVR which is greater than PVR
Concentric hypertrophy
-LV chamber size is normal
-Hypertrophic myocardium from pressure overload
-Causes: chronic HTN, aortic stenosis
-Increased amount of wall stress = increased contractility but also increased O2 demand, @ a point hypertrophy will lead to CHF
-Associated with Law of LaPlace
Eccentric hypertrophy
-Large LV chamber from volume overload
-Causes: ischemic heart dx, MI
-Increased chamber size in r/t increased end-diastolic volume, eventually increased stretch/volume will lead to CHF
-Systolic dysfunction, yet during diastole maintain end-diastolic wall stress = increased O2 demand
Mitral Stenosis
-Normal orifice: 4-6cm2
-Begin of S/S: <2cm2
-Severe stenosis: <1cm2
-Decreased Blood Flow from LA to LV
-If PCWP >25mmHg = increased PVR = Pulm HTN/edema
-Trt: anticoagulatns, Na+ restriction, diuretics, valve replacement
Monitoring for Mitral Stenosis:
PCWP overestimates LVEDP
Prominent A wave, decreased y-descent
Anesthesia Goals for Mitral Stenosis:
Rate: slow
Rhythm: NSR
Preload: maintain
Afterload: maintain
Contractility: maintain
-Caution in SAB, epidural preferred, avoid ketamine/pancuronium, treat tachycardia, trt A-Fib with digoxin/diltiazem but NOT VERAPAMIL b/c greater vasodilating effects, trt symptomatic SVT, drug of choice for hypotension: phenylephrine
Mitral Stenosis Curve:
Leftward shift, decreased amplitude
-Decreased LVEDV + Decreased LVESV = Decreased SV (in severe dx)
Mitral Regurgitation Pathophysiology:
-Acute Causes: papillary muscle dysfuntion, infective endocarditis, trauma
-Chronic Causes: rheumatic fever, valve degeneration
-Result: backflow of blood from LV to LA during systole, can decrease CO
-Volume Overloaded chamber = dilation = eccentric hypertrophy
Mitral Regurgitation Symptoms:
-Moderate Symptoms: 30-60% regurgitant fraction
-Severe Symptoms: >60%
Treatment Mitral Regurgitation:
Inotropes (digoxin, amiodarone), decreased SVR, diuretics, ACE inhibitors, valve replacement
Monitoring Mitral Regurgitation:
-Large V wave, rapid y descent
-PCWP underestimates LVEDP
Anesthesia Goals for Mitral Regurgiation:
Rate: avoid bradycardia, ideal is 80-100bpm
Rhythm: NSR
Preload: maintain
Afterload: maintain
Contractility: maintain
-SAB/epidural good, sensitive to myodcardial depressants, opioid/pavulon if severe
Acute Mitral Regurgitation Curve:
Rightward shift, Increased LVEDV + LVESV, but decreased SV
**Isovolumetric contraction abnormality
Chronic Mitral Regurgitation Curve:
Increased LVESV + LVEDV
Increased SV d/t compensatory eccentric hypertrophy
*Greater SV than normal, Starling's Law
Aortic Stenosis Pathophysiology:
-Normal orifice: 2.5-3.5cm2
-Mild to moderate S/S: 0.7-0.9
-Critical: 0.5-0.7cm2
-Left ventricular outflow tract obstruction = impaired LV ejection, LV hypertrophy, LV failure
-Myocardial thickening, decreased LV compliance, pressure overload = concentric hypertrophy
Aortic Stenosis Symptoms:
dyspnea on exertion, angina, orthostatic hypotension, exertional syncope
Aortic Stenosis Treatment:
Inotropes (Digoxin, amiodarone), Na+ restriction, diurectics, valve replacement
Aortic Stenosis Monitoring:
auscultate systolic murmure 2nd ICS
ECG risk for ischemia
Prominent A wave
Anesthesia Goals for Aortic Stenosis:
Rate: 70-80
Rhythm: NSR
Preload: maintain
Afterload: maintain
Contractility: maintain

*sudden decrease in SVR will make the heart hyperdynamic and activate baroreceptor response
-Avoid hypotension & bradycardia, attempts at CPR futile, Epidural over SAB for mild to moderate AS, opioid based GA, etomidate good, SVT with compromise: cardioversion, Amiodarone drug of choice for SVT, ventricular arrhytmias
Beta Blocker of Choice in Aortic Stenosis:
Vasopressor of Choice in Aortic Stenosis:
Aortic Stenosis Curve:
-Shifted up, slightly right
-Increased LVEDP
-LVEDV remain approximately normal
-Decreased SV in critical AS
Pathophysiology of Aortic Regurgitation:
Acute: trauma, aortic dissection, edocarditis
Chronic: congenital, rheumatic fever, syphillis

Volume overload LV as volume ejected re-enters LV during diastole; Volume overload = chamber dilation = eccentric hypertrophy
**Chronic AR has largest EDV of any heart dx
S/S of Aortic Regurgitation:
-Mild: regurgitant volume less than 40% of SV
-Severe: regurgitant volume exceeds 60% of SV
-Acute AR: hypotension, pulmonary edema, cardiovascular collapse
-Chronic AR: diastolic murmur over 2nd ICS Right chest
Treatment of Aortic Regurgitation:
Inotropes (digoxin, amiodarone), ACE inhibitors, Na+ restriction, valve replacement
Monitoring for AR:
Large V wave, indicitive of left ventricular dilation
Anesthetic Goals for AR:
Rate: increased slightly 80-100bpm
Rhythm: NSR
Preload: maintain
Afterload: slightly decreased
Contractility: maintain

SAB/epidural okay with prehydration, Ephedrine for hypotension
Acute AR Curve:
Rightward Shift
Increased LVEDV
Increased LVESV
Increased LVEDP
Decreased SV
Chronic AR Curve:
Rightward shift
Dramatic increase in LVEDV
Mild increase in LVEDP d/t increased ventricular compliance and contractility
Increased Preload Curve:
-Filling increases
-Increased EDV without change in ESV
-SV increases as a r/o Starling's Law
-Requires increased myocardial O2 demand
-Clinical example: fluid bolus, drug increased venous tone
Decreased Preload Curve:
-Filling decreases
-Decreased EDV without change in ESV
-SV decreases
-Clinical examples: hypovolemia, NTG, diuretics
Increased Afterload Curve:
Increased pressures
Increased EDV
Increased ESV
Shifts curve up and right
Increased O2 demand
Clinical: phenylephrine, SNS stimulation
Decreased Afterload Curve:
Decreased Pressures
Decreased EDV
Decreased ESV
Shifts down and left
Clinical example: Nitroprusside, hydralazine
Increased Contractility Curve:
Higher Pressures
Smaller EDV
Smaller ESV
Increased O2 demand
Increased SV
Shifts up and left
Clinical example: digoxin
Decreased Contractility Curve:
Lower Pressures
Higher EDV
Higher ESV
Shifts down and right
Decreased SV
Clinical Example: CHF, Beta blockers, hypocalcemia
Hypertrophic Cardiomyopathy Curve:
Hypertrophic LV
Left ventricular outflow obstruction
Increased pressure
Decreased EDV
Decreased ESV
Decrased SV
Tachycardia Curve:
Decreased LVEDV
Decreased LVESV
Decreased coronary perfusion
Decreased SV