Flashcard Set Preview
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** Review Pressure-Volume Loop on slide 3**Afterload Mismatch1. as after load increases, what...
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1. as AL and BP increase, AV closes at higher pressure2. as aortic valve closes at higher pressure,...
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Ventricular COmpliance1. acute increases in volume (ex?) produce marked increases in what?2....
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1. (ex: AI/ aortic regurg) --> incr LVEDP2. right/ higher volumes3. inverse linear relationship...
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Measures of Contractility1. contractility= ability to generate __ at a given __2. Isovolumetric...
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1. force/ preload2a. loading conditionsb. basal contractility3a. preloadb. afterloadc. valvular...
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End Systolic Pressure Volume Relationship1. higher EF will result in lower ___2. lower EF will...
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1. end systolic volume index2. end systolic vol index/ and must utilize preload reserve
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1. most common cardiac valve lesion in the US2. 1-2% of population born with what?3. marked...
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1. aortic stenosis2. bicuspid valve instead of tricuspid valve3. bicuspid valve and calcification...
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1. early lesion of AS resembles what?2. coronary calcification correlates highly with what?3....
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1. intimal plaque characteristic of CAD2. aortic valve calcification3. incr LDL, smoking, HTN,...
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1. avg life expectancy after the following symptoms occur?a. anginab. syncopec. DOE secondary...
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1a. 5yrsb. 3yrsc. 2yrs2. operative treatment3. decreased early and late survival4. does not...
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1. 2 times when AVR is indicated2. Aortic Stenosisa. increased __ __ pressureb. increased __...
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1. -- severe AS with any classic symptom (angina, syncope, DOE)-- or asymptomatic severe AS...
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Aortic Stenosis1. ___ is typically well-preserved 2. what is the major threat?3. explain...
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1. contractiliy2. sensitivity of hypertrophied muscle to ischemia3. increased demand from LV...
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Stratification- Contractile Reserve1. a dobutamine test is performed= changes seen in gradient,...
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1. gradient increases, AV area increases or stays the same, cardiac output increases(if CO,...
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**Anesthetic Mgmt of Aortic Stenosis**Primary Goals1. 3 things to maintain2. 3 things to avoid3....
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1. - maintain sinus rhythm- normal to incr PL- normal to incr AL to maintain aortic root pressure...
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1. induction= ideal method?-- important to avoid what?2. maintenance?3. be aggressive in managing...
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1. narcotics ideal but can be done diff ways 2. primarily narcotic + N2O + low dose volatile3....
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AS --> other considerations1. avoid ___2. use extreme caution with what type of anesthesia?3....
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1. vasodilators2. spinal and epidural anesthesia (d/t dcrs SVR)3. MI, CHF, supraventricular...
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Aortic Regurgitation1. originsa. chronic - 3b. acute - 22. describe course of disease?3. symptoms
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1a. rheumatic fever, infective endocarditis, connective tissue d/o's (Marfans)b. aortic dissection...
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Aortic Valve Regurg1. symptoms correlate poorly with what?2. when is there a higher preoperative...
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1. impaired contractility2. once patients develop LV dysfunction3. follow with serial ECG and...
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1. In which of the following situations is AV replacement indicated?a. asymptomatic pt with...
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1a. replacement indicatedb. replacement indicatedc. further evaluation recommended
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1. changes in pressure- volume curve seen with AR2. how are SV and EF maintained?3. which phase...
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1. shift far to right d/t incr in volume2. by using preload volume3. isovolumic diastolic phase...
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1. approx 1/3 of patients will develop ___ in the absence of ___-- this is d/t what?2. why...
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1. angina/ CAD-- d/t disproportionate increase in myocardial mass relative to increase in CBF2....
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Anesthetic Management of Aortic Regurgitation1. 3 primary goals2. avoid what 2 things?3. monitor...
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1. - augment forward flow- increased PL- decreased AL2. bradycardia and myocardial depression3....
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Aortic Regurg1. wide variety of acceptable approaches-- avoid what 2 things?2. maintenance...
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1. bradycardia and increased afterload2. LV dysfunction
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Mitral Regurgitation1. acute and chronic forms produce very different ___2. ACUTEa. commonly...
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1. outcomes2a. papillary muscle dysfunction secondary to AMIb. preload/ LV contractilityc....
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Chronic Mitral Regurg2 types, causes, examples
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1. organic = dz resulting in distortion, disruption, or destruction of the leaflets or chordal...
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Chronic Mitral Regurgitation1. pathophysiologya. diastolic filling of LV consists of what?b....
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1a. normal LA volume + regurgitant volumeb. volume overload of LVc. -- frank-starling (incr...
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Chronic Mitral Regurgitation1. shift of pressure-volume curve2. which phase is a little different?3....
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1. right shift d/t chamber enlargement (eccentric - volume increase; not huge increase in pressure...
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Timing of Repair or Replacement in Mitral Regurgitation1. pre-op EF most accurately predicts...
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1. - long term survival- post-op EF and CHF2. - EF >60%- end- systolic LV diameter <45mm-...
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Anesthetic Mgmt of Mitral Regurg1. 3 primary goals2. avoid what 2 things?3. monitoring= 2 methods4....
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1. - augment forward flow- incr preload- decrease afterload2. bradycardia- myocardial depression3....
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Mitral Regurg1. fluid mgmt= balance btw what 2 things?2. ventilation= adjusted to provide adequate...
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1. adequate preload and overload2. venous return3. mild hyperventilation/ hypoventilation
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Mitral Stenosis1. most frequently d/t what?a. latency prior to symptomsb. age of onset ___c....
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1. rheumatic heart diseasea. 20-30yrsb. increasingc. slow2. females3. dyspnea on exertion (1st...
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Mitral Stenosis1. diagnosis made and progression monitored with what?2. in severe disease,...
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1. ECG2. pressure gradient increases (>10= severe dz); valve area decreases <1.0= severe3....
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Mitral Stenosis1. pres- vol cure shifts which way?2. what 4 things are decreased
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1. down and to the left2. preload reserve, LVEDP, LVEDV, SV
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1. which patients need surgery and which need conservative mgmt?2. 3 procedures that are done?
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1. symptomatic patients (pulm HTN)= surgerymild stenosis with few or mild symptoms= conservative...
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Anesthetic Mgmt of Mitral Stenosis1. 3 primary goals2. avoid what 2 things?3. monitoring -->...
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1. - control of ventricular rate- normal to increased preload- normal afterload2. tachycardia-...
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Mitral Stenosis1. sedation?2. induction = don't use what?3. maintenance= balanced technique...
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1. valuable for avoiding tachycardia but avoid over sedation leading to hypoventilation2. ketamine3....
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Mitral Valve Prolapse1. affects what % of population?-- more common in __ __2. def= valve leaflet...
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1. 1-2.5%-- young women2. >2mm3. dcrs SVR or increased emptying of ventricle
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Heart Murmurs1. 2 valve d/o heard in systole2. 2 valve d/o heard during diastole3. aortic murmurs=...
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1. aortic stenosis and mitral regurg2. aortic regurg and mitral stenosis3. best heard at right...
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