Anesthetic Management
The primary hemodynamic goal for Mitral Stenosis is often summarized by this three-word phrase.
What is "Full, Slow, Constricted"?
Regurgitant valvular pathologies produce this type of remodeling, characterized by the addition of sarcomeres in series and a dilated ventricular chamber.
What is Eccentric Hypertrophy (or Volume Overload)?
$200: On a standard PV loop, the width of the loop represents this value, calculated as EDV - ESV.
What is Stroke Volume (SV)?
The two main phases of the cardiac cycle, normally divided into approximately 1/3 and 2/3 of the cycle's duration, respectively.
What are Systole and Diastole?
In a patient with severe Aortic Stenosis, the induction of anesthesia leads to a sudden drop in SVR. This specific class of medication is the preferred choice for aggressive treatment of the resulting hypotension to maintain coronary perfusion.
What is a direct-acting alpha agonist (e.g., Phenylephrine)?
For patients with Aortic Regurgitation, the goal is to augment forward flow by maintaining this heart rate and afterload status.
What is "Fast and Forward" (increased/normal HR and decreased afterload)?
In this valvular disorder, the PV loop is shifted far to the right with a massive increase in EDV and no true isovolumic diastolic phase.
What is Chronic Aortic Regurgitation?
This specific corner of the PV loop signifies the beginning of Phase III (Ejection) and corresponds to the patient's Diastolic Blood Pressure.
Where the Aortic Valve Opens
During this specific phase of systole, all heart valves are closed and ventricular volume remains constant while pressure increases.
What is Isovolumic (or Isometric) Contraction?
During the management of Mitral Regurgitation, the anesthetist chooses to avoid Nitrous Oxide due to its controversial potential to increase this specific hemodynamic parameter.
What is Pulmonary Vascular Resistance (PVR)?
In the management of Aortic Stenosis, this regional anesthesia technique is considered extremely cautious or even contraindicated due to the risk of profound hypotension.
What is Neuraxial Anesthesia (specifically Spinal)?
Mitral stenosis often leads to this arrhythmia in approximately 1/3 of patients due to left atrial distention.
What is Atrial Fibrillation?
In PV loop nomenclature, Phase IV is known as this, during which the aortic valve has closed but the mitral valve has not yet opened.
What is Isovolumic Relaxation?
This mechanical event, which contributes the last 20% of ventricular filling, occurs at the very end of diastole.
What is Atrial Systole (or Atrial Kick)?
While managing a patient with Aortic Regurgitation, a heart rate of 50 bpm is noted. This clinical state is hazardous because it prolongs diastolic time, directly causing an increase in these two ventricular parameters.
What are LVEDV and LVEDP?
Bradycardia must be avoided in Aortic Regurgitation because a prolonged diastolic time results in this.
What is an increase in regurgitant flow (and rapidly increased LVEDV/LVEDP)?
The "triad" of symptoms for Aortic Stenosis includes these three clinical findings.
What are Syncope, Angina, and Dyspnea?
When using a PV loop to assess contractility, this specific relationship/line is considered a more precise estimate than ejection fraction because it is independent of preload.
What is the End Systolic Pressure Volume Relationship (ESPVR)?
On the Wigger’s diagram, this specific waveform represents the pressure buildup from venous return just before the mitral valve opens.
What is the v wave?
A patient with severe Mitral Stenosis suddenly develops a rapid ventricular response due to Atrial Fibrillation. This is considered a hemodynamic emergency because it severely decreases this time interval, which is critical for ventricular filling.
What is diastolic filling time?
In patients with Aortic Stenosis, a low normal heart rate is preferred primarily to ensure adequate time for this.
What is Coronary Perfusion?
Stenotic valves typically result in this type of remodeling, where sarcomeres are added in parallel, leading to thickened walls and a smaller chamber.
What is Concentric Hypertrophy (or Pressure Overload)?
This term refers to the heart's intrinsic ability to relax, which requires ATP to pump calcium back into the sarcoplasmic reticulum.
What is Lusitropy?
This notch in the aortic pressure waveform is caused by the onset of aortic valve closure and a brief period of retrograde flow.
What is the Dicrotic Notch (Incisura)?
According to Laplace's Law, this specific structural change in Concentric Hypertrophy serves as a compensatory mechanism to maintain or decrease wall stress despite a massive increase in intraventricular pressure. However, this same change eventually reduces ventricular compliance, leading to the "stiff" diastolic curve seen on PV loops.
What is an increase in Ventricular Wall Thickness (VWT)?