A 45-year-old woman with severe mitral stenosis (valve area 0.9 cm²) and pulmonary hypertension is posted for emergency lower segment caesarean section. Which haemodynamic goal is MOST critical during anaesthesia?

• A Maintain tachycardia to improve cardiac output
• B Increase systemic vascular resistance
• C Reduce preload with nitroglycerin
• D Avoid tachycardia and maintain sinus rhythm ✓

Explanation

In mitral stenosis, left ventricular filling depends on the diastolic filling time. Tachycardia shortens diastole and drastically raises left atrial pressure, precipitating pulmonary oedema. Sinus rhythm is critical because atrial contraction contributes significantly to ventricular filling. Loss of atrial kick or onset of tachycardia can be catastrophic.

Reference: Miller's Anaesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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