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Mitral Regurgitation Haemodynamic Goals — FRCA Final MCQ

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ModerateGeneral AnaesthesiaMitral Regurgitation Haemodynamic GoalsFRCA Final

During a pre-operative assessment, a 70-year-old woman is noted to have a systolic murmur. Echocardiography reveals moderate mitral regurgitation with a left atrial diameter of 5.2 cm and AF. Regarding anaesthetic management, the key haemodynamic principle is:

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Correct answer: B — Maximally restrict IV fluids

In mitral regurgitation, the regurgitant fraction is worsened by: slow heart rate (longer systole = more time for backflow), high SVR (increased resistance to forward flow pushes more blood backward), and myocardial depression. Goals: maintain slightly fast heart rate (80-100 bpm), reduce SVR modestly (afterload reduction promotes forward flow), maintain contractility, and maintain adequate preload. Neuraxial techniques are generally well tolerated (SVR reduction). Volatile agents at moderate concentrations provide mild SVR reduction.

Reference: ESC – 2021 – Valvular heart disease; RCOA – 2023 – Cardiac anaesthesia