Systole Question by Anesthesia MD to me

[doctor712]

Hi All,

Have a question I was asked today by either an MD or CRNA and I'd like to ask it of you here...

Observing a CT Surgeon today for a beating heart case, but I was told to introduce myself to the Anesthesiologist by the Surgeon because she knows I want to be an anesthesiologist So I did. I did so when the TEE was being used to visualize the chambers at the beginning of this really long case...which was the wrong time apparently...

Well the first mistake was the surgeon introducing me as a med student, which is sweet, but I'm not. And who am I to correct said heart surgeon. I made the mistake of asking about the leaflets of the mitral valve (which I could see on the TEE) and that was this guy's cue to ask me 1003 questions in the next 3 minutes, 2 of which I had an answer for. I have watched TEE videos on U Mich website and Yale's website and in certain views, longitudinal for example, I can make out some obvious anatomy

The one question that I thought I got right but was told to "guess again" was the following. Is mitral regurgitation a systolic or diastolic problem? We were looking at the valve at the time of this question and he was nice enough to show me the layout of the heart from this view. Reminding me to think Aorta then Anterior then posterior leaflet. (from right to left).
Anyway, I thought a second and said Systolic. Actually, I'm not sure what I said, so I'm asking you guys. He said, "Guess again." So I got it wrong, that much I remember. But I forget at this point what the answer was. 6 hours of heart surgery followed, it was a long day.

Can someone explain?

I really thought that systole is when the LV contracts and fills the aorta, thus the higher pressure in the aorta in systole, when it's full of blood, than diastole. And I thought systole happens as the mitral valve opens, allowing blood into the ventricle, then the aorta? Is this right? If so, then when the valve closes, (but not fully during regurgitation,) it's during Diastole. So mitral valve regurgitation is a diastolic problem? What's the correct answer to this guy's question???? I would love an anesthesiologist to clarify for me if possible.

Thanks,
D712

p.s. my anesthesia nugget of the day was learning that protamine reverses heparin.

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[SleepIsGood]

Typically

during systole, the mitral valve is closed and the Aortic valve is opened. Blood is pumped out of the left ventricle at this time into the Aorta.

During diastole....the mitral valve opens up and allows blood into the left ventricle, from the left atrium.

 

[puraj83]

Mitral valve regurg gives you a high pitched blowing holosystolic murmur. The sound is produced by blood from the LV pushing, actually escaping, through the mitral valve during systole.

 

[Labslave]

The mitral valve is normally open during diastole, allowing blood to fill the left ventricle. It closes during systole. Mitral regurg is a systolic process during which the left ventricle pumps blood "backwards" (hence the term regurgitation) through the mitral valve in addition to pumping it forward through the aortic valve. This can be due to a ton of reasons (go to med school to find out).

 

[G0S2]

In compensated (early) MR, blood is ejected through the aorta and through the MV, but some of the flow through the MV comes back and the left ventricle dilates to compensate for the increased diastolic volume (and diastolic filling pressure-which may be what the doc was getting at).

In uncompensated (late) MR, the left ventricle begins to lose some contractility b/c of the dilation, which is a systolic problem but the diastolic filling pressures remain high as well b/c of the volume of blood in the left ventricle at diastole.

That's my take.

 

[doctor712]

thanks gang! ill be back in OR wednesday and will be ready, with bated breath, for my next lesson!

D712

 

[geauxg8rs]

Learn the difference between MD and CRNA

Quote:
Hi All,

Have a question I was asked today by either an MD or CRNA and I'd like to ask it of you here...

 

[dhb]

Here we go

ps: MR takes place during atrial diastole or ventricular systole if you prefer

 

[doctor712]

With all due respect (GeauxG8rs)...I know the difference between a MD and CRNA. The dude in question was wearing unmarked scrubs as most do here and relieving another " medical professional." This hospital employs CRNAs and MDs. So, unless I checked for his degree in his back pocket, his wallet for student loan debt, or that certain swagger in his walk, I had no way of knowing in the two minutes we spent together. Nor did i care while he quizzed me about the TEE which, as i recall, was the point of my post. But thanks for the advice on lessons in anesthesia. And for the way you presented your advice.
D712

Learn the difference between MD and CRNA

Quote:
Hi All,

Have a question I was asked today by either an MD or CRNA and I'd like to ask it of you here...

 

[geauxg8rs]

no problem, here to help.

 

[Bertelman]

With all due respect (GeauxG8rs)...I know the difference between a MD and CRNA. The dude in question was wearing unmarked scrubs as most do here and relieving another " medical professional." This hospital employs CRNAs and MDs. So, unless I checked for his degree in his back pocket, his wallet for student loan debt, or that certain swagger in his walk, I had no way of knowing in the two minutes we spent together. Nor did i care while he quizzed me about the TEE which, as i recall, was the point of my post. But thanks for the advice on lessons in anesthesia. And for the way you presented your advice.
D712

fwiw, if he was running the TEE, I damn well hope he was an MD.

 

[doctor712]

fwiw, if he was running the TEE, I damn well hope he was an MD.

Well, I grew curious myself and looked up the departmental website for the guy who questioned me. Dude is a MD, confirmed with a headshot, for what it's worth. Great credentials too.

D712