Download Clinical Anesthesiology (4th Edition) by Michael Murray, G. Morgan, Maged Mikhail PDF

By Michael Murray, G. Morgan, Maged Mikhail

Scientific Anesthesiology integrates succinct assurance of easy rules and medical issues within the anesthetic administration of sufferers. It positive factors up to date dialogue of all appropriate parts inside anesthesiology, together with apparatus, pharmacology, neighborhood anesthesia, pathophysiology, ache administration, anesthetic administration, and significant care. huge use of case discussions, figures, and tables in every one bankruptcy promotes program of the techniques to perform.

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ACP Medicine. In Gibbons RJ (ed): Cardiovascular Medicine IX. , 2004. 25 CHAPTER 2 Valvular Heart Disease Adriana Herrera Preoperative Evaluation  History and Physical Examination  Drug Therapy  Laboratory Data  Presence of Prosthetic Heart Valves  Prevention of Bacterial Endocarditis Mitral     Stenosis Pathophysiology Diagnosis Treatment Management of Anesthesia Mitral     Regurgitation Pathophysiology Diagnosis Treatment Management of Anesthesia Mitral Valve Prolapse  Diagnosis  Management of Anesthesia In the past 2 decades, there have been major advances in understanding the natural history of valvular heart disease and in improving cardiac function in patients with valvular heart disease.

Diagnosis The definitive diagnosis of MVP is based on echocardiographic findings. It has been defined as valve prolapse of 2 mm or more above the mitral annulus. MVP can occur with or without leaflet thickening and with or without mitral regurgitation. Patients with redundant and thickened leaflets have a primary (anatomic) form of MVP. This form of MVP typically occurs in patients with connective tissue diseases or in elderly men. Patients with mild bowing and normal-appearing leaflets have a normal variant (functional) form of MVP, and their risk of adverse events is probably no different than that of the general population.

When the mitral valve area is less than 1 cm2, a mean atrial pressure of about 25 mm Hg is necessary to maintain adequate left ventricular filling and resting cardiac output. Pulmonary hypertension is likely if the left atrial pressure is chronically above 25 mm Hg. When the mitral transvalvular pressure gradient is higher than 10 mm Hg (normally < 5 mm Hg), it is likely that mitral stenosis is severe (Table 2-6). When mitral stenosis is severe, any additional stress such as fever or sepsis may precipitate pulmonary edema.

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