Valvular Heart Disease – Tutorial of the Week

Dr Richard Telford Valvular Heart Disease 1. You visit a patient who is due to have an orthopaedic procedure. He tells you he gets occasional chest pain and shortness of breath on exertion. You notice he has an ejection systolic murmur. What investigations should you obtain if possible? 2. You are asked to anaesthetise a patient who has known mitral stenosis who has broken their tibia and fibula. The orthopaedic surgeons want to perform an MUA. The patient tells you he gets short of breath on exertion. What is the best way to anaesthetise him? 3. You visit a patient before their hernia operation. They are perfectly fit and can “walk miles”. You notice they have a ejection systolic murmur when you listen to their chest. Should you proceed with the proposed surgery or perform further investigations? 4. Which patients tolerate general anaesthesia better? Those with stenotic heart valve disease or those with regurgitant heart valve disease? 5. Which patients require antibiotic prophylaxis to prevent bacterial endocarditis? Introduction Valvular heart disease is found in 4% of patients over the age of 65 in the developed world. Patients may already be under a cardiologist with a known valve problem. Sometimes a murmur may be picked up during preoperative assessment. In each case the anaesthetist must: • Assess the significance of the cardiac lesion for the proposed surgery • Plan anaesthesia according to the haemodynamic picture • Remember to ...