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Cardiac/Vascular Surgery (Diagnostic Testing (Aortic Valve (Regurgitation,…
Cardiac/Vascular Surgery
Etiology
Aortic valve
Stenosis: narrowing of aortic valve, impeding LV emptying
Congenital anomaly or valve calcification, rheumatic heart disease, hypercholesterolemia
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Mitral valve
Stenosis: Narrowing of the mitral valve, impeding LV filling
Rheumatic disease, calcification, infective endocarditis
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Diagnostic Testing
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Mitral valve
Stenosis
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ECG: LA dilation, A-fib, and RV hypertrophy
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Respiratory Management
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Mitral valve
Stenosis
Diuretics, beta and calcium-channel blockers, digoxin for A-fib; anticoagulation's (emboli)
Regurgitation
Vasodilators to reduce afterload, valve repair or replacement
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Pathophysiology
Aortic valve
Stenosis
Over time, back-pressure causes LV hypertrophy, leading to either diastolic failure or ischemia (O2 demand exceeds supply)
Regurgitation
LV volume and pressure overload, causing dilation and hypertrophy
Mitral valve
Stenosis
Accentuated first heart sounded P2 if pulmonary hypertension; exertional dyspnea, fatigue, angina, plus signs of RV failure
Regurgitation
Panystolic murmur, dyspnea, PND, orthopnea fatigue, and palpitations caused by A-fib
Cardiac surgery is associated with pulmonary complications. Diminished postoperative FRC increases atelectasis/ Reduced VC and impaired airway clearance due to pain and analgesics make the patient prone to secretion retention and pneumonia
Fluid imbalance and the general inflammatory response to surgery often increase capillary leakage and lung water, further aggravating V/Q inequalities and worsening hypoxemia