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stenotic lesions cause _________ overload

pressure

regurgitant lesions cause _________ overload

volume

coronary stenotic lesions: avoid ______ and ______

AVOID increased heart rate and decreased SVR

normal mitral valve area

4-6 sq. cm.

surgical mitral stenosis area

less than 1 sq cm

surgical mitral valve pressure graident

greater than 10 mm Hg

normal aortic valve area

2.5-3.5 sq cm

surgical aortic stenosis area

less than 0.75 sq cm

surgical aortic pressure gradient

greater than 50 mm Hg

mitral stenosis leads to fixed ____ and increased _____

FIXED cardiac output, INCREASED pulmonary pressures

if left untreated, mitral stenosis can lead to

pulmonary edema and RV failure

most common cause of mitral stenosis

rheumatic carditis

what cardiac rhythm often accompanies mitral stenosis? (why?)

atrial fibrillation; chronic increased back pressure causes atrial dilatation

are digitalis levels necessary prior to surgery in setting of atrial fibrillation?

no; goal is rate control rather than drug level

why avoid tachycardia in stenotic valvular disease?

tachycardia severely reduces cardiac output; limits diastolic filling of left ventricle; decreases diastolic corony perfusion time

normal atrial kick contribution

20% of CO

atrial kick contribution in mitral stenosis

35% of CO

reason to avoid isoflurane in setting of mitral stenosis

decreases SVR and increases HR

first two steps in management if SVT develops in setting of mitral stenosis

1) digitalis. if fails, then 2) DC-cardioversion

symptoms of aortic stenosis

syncope, angina, dyspnea-CHF

why avoid decreased SVR in stenotic valvular disease?

compromises aortic diastolic blood pressure and coronary perfusion pressure

survival expectancy in patient with AS presenting with angina

5 years

survival expectancy in patient with AS presenting with CHF

3 years

survival expectancy in patient with AS presenting with syncope

1 year

most common cause of isolated aortic stenosis

congenital bicuspid valve

how does heart maintain forward flow in setting of aortic stenosis?

LV systolic pressure increases with an increase in wall tension; compensatory response is concentric ventricular hypertrophy

Hemodynamic goal in aortic stenosis: preload

keep it full; patient must have adequate volume to fill noncompliant ventricle

Hemodynamic goal in aortic stenosis: afterload

don't decrease systemic vascular resistance

Hemodynamic goal in aortic stenosis: rate

don't allow tachycardia. it will lead to poor filling and ischemia

long standing atrial fibrillation: necessary to cardiovert before surgery?

no; may actually increase risk of embolism

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