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mitral stenosis leads to fixed ____ and increased _____
FIXED cardiac output, INCREASED pulmonary pressures
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
first two steps in management if SVT develops in setting of mitral stenosis
1) digitalis. if fails, then 2) DC-cardioversion
why avoid decreased SVR in stenotic valvular disease?
compromises aortic diastolic blood pressure and coronary perfusion pressure
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: rate
don't allow tachycardia. it will lead to poor filling and ischemia
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