Managing The Patient with IHSS Comprehensive Study Guide With Complete Answers.

(HOCM) - correct answer Hypertrophic Obstructive Cardiomyopathy the cardiac disorder also known as IHSS Hypertrophic Obstructive Cardiomyopathy the cardiac disorder known for its Asymmetric - correct answer thickening of the left ventricle Hypertrophic Obstructive Cardiomyopathy pathophysiology is related to the - correct answer development of left ventricular outflow tract obstruction (LVOT) and ventricular dysrhythmias Hypertrophic Obstructive Cardiomyopathy Hallmark sign - correct answer left ventricular hypertrophy Hypertrophic Obstructive Cardiomyopathy (HOCM) can present with or without - correct answer Obstruction Hypertrophic Obstructive Cardiomyopathy is the most common - correct answer genetic cardiovascular disease and is transmitted as an autosomal dominant trait with variable penetrance Hypertophic Obstructive Cardiomyopathy (HOCM) histologic features include - correct answer hypertrophied myocardial cells and areas of patchy myocardial scarring Hypertophic Obstructive Cardiomyopathy (HOCM) LV hypertophy develops - correct answer in the absence of any other cardiac disease capable of causing hypertrophy i.e. HTN or Aortic Stenosis Hypertophic Obstructive Cardiomyopathy (HOCM) pathophysiology - correct answer -Myocardial hypertrophy -Systolic anterior movement of mitral valve causing mitral regurgitation -Diastolic dysfunction (normal EF) -Myocardial ischemia -Dysrhythmias -Some may have left ventricular outflow obstruction (LVOT) Left Ventricular Outflow Track Obstruction (LVOT) - correct answer -Enlarged ventricular septum -Massive LV hypertrophy -Small chamber size -Systolic anterior motion of mitral valve (SAM) -may be present at rest or can be induced by the Valsalva maneuver A hypertrophied myocardium has a - correct answer prolonged relaxation time and decreased compliance hypertrophied myocardium is worsened by - correct answer enhanced contractility, decreased ventricular volume and decreased afterload Principal Symptoms in HOCM - correct answer -Angina -Dyspnea and fatigue -Syncope -Palpitations/tachydysrhythmias Principal Symptoms in HOCM: Angina - correct answer usually occurs with exercise or physical activity, but also may occur with rest or after meals. Principal Symptoms in HOCM : Dyspnea and fatigue - correct answer -especially with exertion -symptoms are more common in adults and are most likely caused by backup of pressure in the left atrium and to the lungs. Principal Symptoms in НОСМ: Syncope - correct answer -affects about 15 to 25% -Maybe caused by irregular heart rhythms Principal Symptoms in НОСМ: Palpitations/tachydysrhythmias - correct answer -Loose 30% of cardiac output with afib -Blood sitting may cause clots A fib or V tach A fib occurs in 25% with an increased risk for blot clots and heart failure. Preoperative findings of HOCM FIRST CLUE? - correct answer systolic murmur Preoperative findings in HOCM - correct answer -Double apical pulse or gallop rhythm. -Murmurs result from LV obstruction or mitral regurg -Valsalva, which increase LV outflow obstruction will enhance the murmur best heard along the left sternal border EKG findings in HOCM - correct answer -signs of Left ventricular hypertrophy -ST segment and T wave alterations changes -Abnormal "q" Waves (usually seen in MI) HOCM TREATMENT MODALITIES :Medical - correct answer -Beta Blockade -Ca Channel Blockers -Amiodarone HOCM TREATMENT MODALITIES Surgical - correct answer -Septal Myomectomy -Alcohol Ablation -Pacemaker -AICD ANESTHETIC CONSIDERATIONS for HOCM - correct answer -minimize outflow obstruction... -Augment filling pressures and afterload -Decrease heart rate and myocardial contractility -preserving stroke volume and considering drugs that mildly depress contractility(i.e volatile anesthetics) HOCM ANESTHETIC CONSIDERATIONS (things to Avoid) - correct answer -Avoid tachycardia and sympathetic discharge -Avoid PEEP -Avoid decreases in preload and SVR -Avoid increases in myocardial contractility -Avoid Sympathetic stimulation, hypovolemia and vasodilation worsen LVOT Anesthetic Plan of Care for HOCM - correct answer -Versed to decrease anxiety and SNS stimulation -Maintain Preload with IVF prior to induction -Avoid a large decrease in SVR and increased HR at induction -Smaller TV and increased RR may help When it comes to managing a patient with HOCM careful with - correct answer insufflation, -If you instaflate to fast can cause asystole and hypotension -May see bradycardia In patients with HOCM avoid drugs that release - correct answer Histamine (cause vasodilation) HOCM Hemodynamic Goals-Preload: - correct answer Full, volume is one of first treatments for hypotension HOCM Hemodynamic Goals-Afterload: - correct answer Increased, treat hypotension aggressively with alpha adrenergic agonists (Phenylephrine) HOCM Hemodynamic Goals-Contractility: - correct answer Prefer mild depression HOCM Hemodynamic Goals-Rate: - correct answer Normal range; beta-blockers decrease LVOT gradient and increase LV end-diastolic pressure HOCM Hemodynamic Goals-Rhythm: - correct answer Sinus rhythm is crucial: atrial pacing modalities may be helpful In HOCM management it is important to avoid - correct answer Anticholinergics (if possible) Preoperative Evaluation for HOCM - correct answer -Optimized medical management -Focused physical exam