These are 10 points you can remember about a particular subjects.Tthese 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.
- Acute MRis ususlly due to myocardia ischemia, infective endocarditis, or chest trauma.
- Chronic MR is due to rheumatic fever, congenital abnormality in valve apparatus.
- The principal derangement is reduction inforward stroke volume causing symptoms of low cardiac output.
- Chronic MR usually presents as low COP symptoms because left atrium has time to dilate and accomodate the reguritanat blood.
- Acute MR presents as pulmonary congestion or hypertension, because aleft atrium dose not have time to dilate to accomodate the reguritant blood.
- Anesthetic goals: avoid bradycardia, increase in afterload( both will increase the regurgitant volume), hear rate should ideally kept between 80-100/m.
- Premedication may decrease stress elevation of afterload but shoyld be used cautiously as co2 elevation may increase pulmonary pressure in patient with pulmonary hypertension.
- Spinal and epidural cen be tolerated in patients with preserved ventricular function.
- Opioid based technique is preferrable to inhalational agents in patients with moderate to severe ventricular impairment.
- Pancuronium can be useful slection of muscle relaxant agents in combination with opioids.
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