Gastric POCUS, 3-Part Episode

The patient above has two different cardiac conditions with both coronary disease and mitral regurgitation and the hemodynamic goals of both disease processes should be considered. Patients with mitral regurgitation do not tolerate increases in afterload because this will increase the regurgitant fraction and reduce forward cardiac output. High normal heart rates reduce left ventricular volumes and will lessen mitral regurgitation caused by annular dilation as is seen in ischemic mitral regurgitation. As the patient also suffers from coronary disease, it is important to avoid tachycardia because this may worsen ischemia and ischemic mitral regurgitation. Preload should be maintained but not increased. Low normal heart rate, increased preload, and increased afterload are the hemodynamic goals for stenotic lesions.