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apex review > Cardiovascular pathophysiology 3 > Flashcards

Cardiovascular pathophysiology 3 Flashcards

1
Q

Identify the anesthetic considerations for constrictive pericarditis (Select 2).
a. Kussmaul’s sign is usually present
b. it is most commonly caused by a virus
c. afterload should be reduced
d. bradycardia should be avoided

A

a. Kussmaul’s sign is usually present
d. bradycardia should be avoided

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2
Q

The _______ surrounds the heart.

A

Pericardium

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3
Q

What three conditions affect the pericardium?

A

acute pericarditis
constrictive pericarditis
cardiac tamponade

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4
Q

Acute pericarditis is usually the result of

A

inflammation

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5
Q

Acute pericarditis does not _______________ unless inflammation leads to constrictive pericarditis or cardiac tamponade.

A

reduce diastolic filling

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6
Q

Constrictive pericarditis is caused by

A

fibrosis or any condition where the pericardium becomes thicker

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7
Q

Treatment for constrictive pericarditis is

A

pericardiotomy

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8
Q

Anesthetic considerations for constrictive pericarditis include

A

avoiding bradycardia, preserving contractility, and maintaining afterload

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9
Q

The pericardium is composed of

A

two layers: the visceral layer is attached to the myocardium
the parietal layer is anchored in the mediastinum

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10
Q

The most common cause of acute pericarditis is

A

infection (viral)

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11
Q

S/S of constrictive pericarditis includes

A

Kussmaul’s sign- JVD during inspiration
Pulsus paradoxus (decreased SBP > 10 mmHg during inspiration)
Increased venous pressure–> distended neck veins, hepatomegaly, ascites, peripheral edema
atrial dysrhythmias
pericardial knock

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12
Q

The most common complication of pericardiotomy is

A

hemorrhage and dysrhythmias

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13
Q

Treatment for acute pericarditis is

A

it usually resolves spontaneously
drugs are given to relieve pain

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14
Q

Symptoms of acute pericarditis include

A

pericardial friction rub
ST elevation with normal enzymes
fever
acute chest pain with pleural component

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15
Q

Identify the components of Beck’s triad (select 3).
a. increased pulmonary artery occlusion pressure
b. hypotension
c. tachycardia
d. jugular vein distension
e. muffled heart tones
f. mill wheel murmur

A

b. hypotension
d. jugular vein distension
e. muffled heart tones

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16
Q

Pericardial effusion is the

A

accumulation of fluid inside the pericardial sac

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17
Q

Pericardial effusion is not _______________ and seldom requires __________

A

an emergency; intervention

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18
Q

_______ is the best method of diagnosis for pericardial effusion

A

TEE

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19
Q

What is the difference between pericardial effusion and cardiac tamponade?

A

cardiac tamponade also results from fluid accumulation inside the pericardium, however the pericardial pressure is high enough to compress the myocardium

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20
Q

Clinical presentation of cardiac tamponade includes

A

Beck’s triad
pulsus paradoxus
Kussmaul’s sign
reduced EKG voltage

21
Q

Describe Beck’s triad.

A

fluid accumulation in the pericardial sac–> muffled heart tones
decreased venous return to the right heart–> jugular venous distension
decreased stroke volume–> hypotension

22
Q

What is Kussmaul’s sign?

A

JVD on inspiration
increased CVP

23
Q

A patient with blunt chest trauma presents for pericardiocentesis. He exhibits jugular venous distension and Kussmaul’s sign. What is the best induction agent for this patient?
a. propofol
b. etomidate
c. ketamine
d. midazolam

A

C. Ketamine

24
Q

Surgical management of cardiac tamponade includes

A

pericardiocentesis (needle aspiration)
pericardiostomy

25
Q

What type of anesthetic is preferred for cardiac tamponade surgery?

A

local anesthesia over GA (d/t better hemodynamic stability)

26
Q

If GA is required for cardiac tamponade, what drugs should be used?

A

drugs that preserve myocardial function:
ketamine
nitrous oxide
benzodiazepines
opioids

27
Q

What should be done in regards to heart rhythm, preload, afterload, and contractility with cardiac tamponade?

A

maintain NSR
preload
afterload
& contractility

28
Q

What kind of ventilation is preferred with cardiac tamponade surgery?

A

spontaneous ventilation over PPV

29
Q

What are the three approaches to pericardiostomy?

A

subxiphoid
thoracoscopic
thoracotomy

30
Q

Complications of pericardiostomy and pericardiocentesis include

A

pneumothorax
re-accumulation of pericardial fluid
puncture of the coronary vessels or myocardium

31
Q

A patient present to the preoperative clinic with a previous history of infective endocarditis. Which procedure puts this patient at the HIGHEST risk of an adverse outcome?
a. cystoscopy
b. colonoscopy
c. dental implant
d. coronary stent placement

A

c. dental implant

32
Q

Infective endocarditis is typically a

A

bacterial infection of the heart valves and endocardium

33
Q

Antibiotic prophylaxis against endocarditis is NOT required for

A

mitral valve prolapse
CABG
or coronary stent placement

34
Q

IV antibiotics for IE prophylaxis cinlude

A

ampicillin
cefazolin
ceftriaxone
clindamycin

35
Q

The current ACC/AHA guidelines advocate for antibiotic prophylaxis only if the patient is

A

at higher risk of developing IE- risk is a function of patient and surgery related factors

36
Q

Patient-factors that increase risk for infective endocarditis include

A

history of IE, prosthetic heart valve, and certain congenital heart defects
repaired congenital heart defect if the repair is <6 months old
unrepaired cyanotic congenital heart disease
heart transplant with valvuloplasty
repaired CHD with residual defects that have impaired endothelization at the graft site

37
Q

Surgery-related factors that increase risk for infective endocarditis includ

A

“dirty” procedures such as dental procedures with gingival manipulation, certain respiratory procedures, and biopsies of infected lesions

38
Q

Which intervention is MOST likely to precipitate hemodynamic instability in the patient with obstructive hypertrophic cardiomyopathy?
a. esmolol
b. nitroglycerin
c. phenylephrine
d. 500 mL 0.9% NaCl bolus

A

b. nitroglycerin

39
Q

_______________ is the most common cause of sudden cardiac death in young athletes.

A

Hypertrophic cardiomyopathy

40
Q

Hypertrophic cardiomyopathy leads to _____________ during systole.

A

left ventricular outflow tract obstruction

41
Q

Causes of left ventricular outflow tract obstruction include

A

congenital hypertrophy of the interventricular septum
systolic anterior motion of the anterior leaflet of the mitral valve

42
Q

Common conditions that worse LVOT include

A

decreased preload
increased contractility
decreased afterload

43
Q

Key treatments for worsening LVOT include

A

beta-blockers
calcium channel blockers
fluids
phenylephrine

44
Q

What are all the names for hypertrophic cardiomyopathy?

A

obstructive hypertrophic cardiomyopathy
hypertrophic obstructive cardiomyopathy
asymmetric septal hypertrophy
idiopathic hypertrophic subaortic stenosis

45
Q

What are the three determinants of blood flow through the LVOT?

A

systolic LV volume
the force of LV contraction
the transmural pressure gradient

46
Q

Conditions that distend the LVOT are _____________, while things that narrow the LVOT are

A

good; bad

47
Q

What will narrow the LVOT?

A

decreased systolic volume
increased contractility
decreased transmural pressure

48
Q

Surgical options for LVOT include

A

mitral valve replacement (can reduce SAM)
septal myomectomy removes a portion of the septum and improves the transmural pressure gradient
alcohol injection into the septal perforator arteries causes ischemic injury to the septum and improves the transmural pressure gradient

apex review (224 decks)

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