Special anaesthesia: mitral stenosis: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Special anaesthesia: mitral stenosis

Sample item

A patient with severe mitral stenosis is to receive a general anaesthetic. Which haemodynamic goal is most important?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Avoid tachycardia to keep diastolic filling time long

In mitral stenosis, flow across the narrowed valve occurs in diastole. Tachycardia shortens diastole, raises left atrial pressure and can precipitate pulmonary oedema. Drugs that cause tachycardia, such as pancuronium, ketamine and atropine, are best avoided.

Option by option

  • A. Lower preload aggressively with vasodilators

    Preload must be maintained because the stenotic valve limits left ventricular filling.

  • B. Induce tachycardia to increase cardiac output

    Tachycardia reduces filling time and worsens left atrial pressure.

  • C. Avoid tachycardia to keep diastolic filling time long (correct)

    Correct. A slow heart rate gives the longest diastolic filling time across the stenotic valve.

  • D. Maximise heart rate with pancuronium

    Pancuronium is vagolytic and causes tachycardia, which is harmful here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Avoid tachycardia to keep diastolic filling time long. In mitral stenosis, flow across the narrowed valve occurs in diastole.

Why is "Lower preload aggressively with vasodilators" not the answer?

Preload must be maintained because the stenotic valve limits left ventricular filling.

Why is "Induce tachycardia to increase cardiac output" not the answer?

Tachycardia reduces filling time and worsens left atrial pressure.

Why is "Maximise heart rate with pancuronium" not the answer?

Pancuronium is vagolytic and causes tachycardia, which is harmful here.

What concept does this question test?

It tests Special anaesthesia: mitral stenosis in Anaesthesia. Tachycardia shortens diastole, raises left atrial pressure and can precipitate pulmonary oedema. Drugs that cause tachycardia, such as pancuronium, ketamine and atropine, are best avoided.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Special anaesthesia: mitral stenosis?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.