ANES 501 Part 2: Valvular Disease & Pressure-Volume Loops EXAM MASTERY GUIDE 2025: 58 Expert-Curated Q&A with Detailed Rationales, Hemodynamic Principles, and Surgical Intervention Strategies

B-C?

I- ventricular filling

C-D?

II- Isovolumetric contraction

D-A?

III- systolic ejection

A-B?

IV- isovolumetric relaxation

A?

aortic valve closes

B?

mitral valve opens

C?

mitral valve closes

D?

aortic valve opens

ejection fraction?

amount of blood ejected from LV with each beat- 60-75% normal

how do you find ejection fracture?

edv-esv/edv

normal end diastolic volume?

120 ml

normal end systolic volume?

50 ml

normal stroke volume?

70 ml

how do you calculate stroke volume?

edv-esv

what is preload?

wall tension on the left ventricle at the end of diastole- LVEDP; pressure depends on volume- depends on compliance

what is afterload?

wall tension on the heart right before aortic valve opens- aortic systolic pressure- SVR- the less the resistance, the faster/stronger the contraction

increased inotropy on the p/v loop?

increased ejection velocity, increased SV, increased EF, decreased ESV

decreased inotropy on the p/v loop?

decreased ejection velocity, decreased SV, decreased EF, decreased ESV

increased preload on the p/v loop?

increased filling, increased EDV, will eject to the same ESV, increased SV

decreased preload on the p/v loop?

decreased filling, decreased EDV, will eject to same ESV, decreased SV

increased afterload on the p/v loop?

prolonged contraction phase to eject volume because required higher pressures, decreased SV, increased ESV

decreased afterload on the p/v loop?

increased SV, decreased ESV

aortic stenosis?

need higher pressures to get blood out of the aorta- elevated loop- increased ESV because unable to get volume out

management of aortic stenosis (hr, rhythm, preload, afterload, contractility)

HR- avoid brady want 60-90, maintain sr, preload maintain or increase, afterload main or increase, contraciltiy maintain

why do want to avoid bradycardia with AS?

cardiac output will fall due to decreased stroke volume

why do want to maintain NSR in AS?

loss of atrial kick will decrease sv and ventricular filling by 40%

why do we maintain/increase preload in AS?

need to keep contractility- frank starling law

why do want to maintain/increase afterload in AS? what medication do we avoid?

perfuses the coronary arteries and maintains perfusion pressure because outflow from aorta is so weak -- NO PROP will decrease SVR, careful with volatile agents

mitral stenosis?

narrowing of mitral valve, unable to get blood from la to lv- low edv

management of mtiral stenosis? (HR, rhythm, preload, afterload, contractility?

HR- avoid tachy Rhythm- nsr, preload- maintain or slightly increase, afterload- maintain svr but avoid increase in pvr, contractility- maintain

why do want to increase preload in mitral stenosis?

assist with ventricular filling - avoid pulmonary edema due to back up

why do we want to maintain svr but avoid increase in pvr in mitral stenosis?

need to make sure blood gets to left side of heart

why do want to decrease hr in mitral stenosis?

allow for adequate filling of lv

aortic regurgitation? (edv, esv, sv, pressure)

increased EDV due to backflow of blood into left ventricle; ESV increased, increased SV due to more blood, increased pressure, diastolic murmur

side effects of aortic regurg? (5)

1. widened pulse pressure 2. dilated LV and eccentric hypertrophy 3. can lead to right sided heart issues 4. increased 02 demand/decreased availability 5. increased pvr and right sided heart failure

management of aortic regurg (hr, rhythm, preload, afterload, contracitlity?

HR- increase, rhythm- nsr, preload- maintain, afterload- decrease, contractility- maintain

why do we want to increase heart in aortic regurg?

shorten diastole, decreased filling, decreased regurg and increases co

why do want to maintain preload in aortic regurg?

frank starling law to allow for contraction

why do want to decrease afterload in aortic regurg?

decrease backflow- mixed agonist ephedrine over neo

mitral regurgitation?

increased EDV, lots of volume left in LA, trouble moving to left ventricle, increased SV, loud systolic murmur

mitral regurg side effects? (3)

1. lv becomes dilated 2. eccentric hypertrophy 3. large v wave on pa catheter

mitral regurg management (hr, rhythm, preload, afterload, contractility)?

hr- maintain or increase, rhythm- nsr, preload- maintain or increase, afterload- decrease, contractility- maintain

why do want to increase hr in mitral regurg?

brady worsens regurg

why do we want to main or increase preload in mitral regurg?

maintain co- frank starlings law

why do we want to decrease afterload in mitral regurg?

to maintain forward flow

monitoring for valvular surgery?

art line, cvc, pa-c, foley with temp, tee, bis, cerebral oximetry, standard asa monitors

what is the standard of care intraoperative for valvular surgery?

tee

what is the most common valvular disease?

aortic stenosis

what type of problem is aortic stenosis?

pressure issue- leading to increased thickness, decreased radius, and decreased oxygen supply with increased demand

what is the hallmark of aortic stenosis?

decreased chamber compliance with concentric hypertrophy

what is the SAD triad?

morbidity rate of aortic stenosis- syncope in 3 years is 15%, angina in 5 years is 35%, dyspnea in 2 years is 50%

normal aortic valve diameter? severe?

2.5-3.5; < 0.8

what happens to the transvalvular gradient in mitral stenosis?

increased- overfilled la and underfilled lv- decreased sv, decreased co, decreased edv

what does mitral stenosis lead to? (5)

1. increased pap 2. increased rv workload 3. rv failure 4. cor pulmonale 5. increased risk for a-fib due to rv dilation

what is normal mitral valve diameter? severe? la-lv gradient? pasp?

4-6; < 1; > 10 mm hg; > 50 mm hg

what factors increased aortic regurg? (3)

1. bradycardia leads to increased filling 2. increased svr (use ephedrine) 3. large orifice

acute aortic insufficiency? (4)

increased edv, increased wall tension, and decreased contractility leads to pulmonary venous congestion

chronic aortic insufficiency? (30

1. no relaxation because valve doesnt close 2. increased esv during diastole due to back flow 3. increased edv