Mitral stenosis, role of 10

What is the role of 10?

These are 10 points you can remember about a particular subjects.
These 10 points if you speak about during your viva session your examiner will be thrilled.
If you expand each point during written exam you can cover the subject effeciently.
If you apply them clinically you patient is saved.

Mitral stenosis(MS)

1. MS is almost always caused by rheumatic fever, commonly in conjunction with other valvular lesions

2. MS---left atrial volume and pressure overload----LA dilataion----increased PVR---pulmonary hypertension----right ventricular hypertrophy and failure.

LA dilatation--- promotes AF and embolic events.

3. Graded into

                                                   Mild                     Moderate                           severe

MITRAL VALVE AREA         2-1.5 cm                   2 1.6-1                                ˂1

Lv-LA pressure gradient           2-6 mmHg                 6-12                                    ˃ 12

Pressure half time                       100ms                       200                                      300

4. Anesthetic goals

•  maintain sinus rhytm 
• Avoid tachycardia 
• Avoid hypovolemia, hypervolemia

5. Patients are very sensitive to the vasodilating effect of spinal and epidural technique

6. Induction is with standard IV agents with possible exception of ketamine

7. Maintainance is with opioid based technique

8. N2O may increase PVR and cause pulmonary hypertension

9. Vecuronium, rocuronium can be used as muscle relaxant. Pancuronium is best avoided.

10. Phenylephrine is preferred as vasopressor over ephedrine because it lacks B agonist aactivity.