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Apex Review > Cardiovascular pathophysiology 4 > Flashcards

Cardiovascular pathophysiology 4 Flashcards

1
Q

A patient with a bare-metal cardiac stent presents for a bunionectomy. What is the minimal amount of time that the patient should wait before she undergoes surgery?

A

30 days

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2
Q

A patient who receives a coronary stent requires

A

dual antiplatelet therapy to prevent stent thrombosis

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3
Q

Dual antiplatelet therapy consists of

A

aspirin
thienopyridine (usually clopidogrel or ticlopidine)

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4
Q

Withholding DAPT therapy after a coronary stent leads to

A

increased risk of thrombus formation and myocardial infarction

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5
Q

Continuing DAPT therapy after a coronary stent when doing another surgical procedure leads to

A

increased bleeding risk

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6
Q

The duration to wait for elective surgery after angioplasty without stent is

A

2-4 weeks

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7
Q

The duration to wait for elective surgery after bare metal stent placement is

A

1-3 months

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8
Q

The duration to wait for elective surgery after drug eluting stent is

A

6-12 months

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9
Q

How many days should clopidogrel be stopped before surgery?

A

7 days

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10
Q

How many days should ticlopidine be stopped before surgery?

A

14 days

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11
Q

For must surgeries, ______ can be continued throughout the perioperative period.

A

aspirin

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12
Q

________________- should NOT be used to “bridge” patients who’ve stopped all antiplatelet therapy.

A

Unfractionated heparin or LMWH
-heparin paradoxically increases platelet aggregation in the stent leading to an increased risk of thrombosis

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13
Q

The best treatment for stent thrombosis is

A

PCI- best outcome is achieved if blood flow is restored in <90 minutes

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14
Q

How long should elective surgery be delayed after a CABG?

A

6 weeks (3 months preferred)

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15
Q

Priming the cardiopulmonary bypass machine with a balanced salt solution reduces all of the following EXCEPT:
a. microvascular flow
b. plasma drug concentration
c. oxygen-carrying capacity
d. blood viscosity

A

a. microvascular flow

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16
Q

__________________ allows the surgeon to operate on an immobile heart.

A

Cardiopulmonary bypass

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17
Q

How does bypass work?

A

once the blood flows into the bypass circuit, O2 is added and CO2 is removed

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18
Q

Blood returning to the patient from the bypass machine resembles

A

arterial blood

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19
Q

Patients on CPB are rendered _____________- to reduce __

A

hypothermic to reduce metabolic rate

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20
Q

A ___________ pump is preferred over a ____________ pump

A

centrifugal; roller

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21
Q

A ____________ oxygenator is preferred over a ______________ oxygenator.

A

membrane; bubble

21
Q

A ____________ oxygenator is preferred over a ______________ oxygenator.

A

membrane; bubble

22
Q

If priming the pump with a balanced salt solution, you should expect

A

hemodilution

22
Q

If priming the pump with a balanced salt solution, you should expect

A

hemodilution

23
Q

_______________ can occur if air enters the

A

An airlock; venous line

24
Q

The _______________ is the component of the CBP machine where gas exchange occurs (it replaces the lungs)

A

oxygenator

25
Q

Why is a bubble oxygenator not preferred?

A

uses a blood-gas interface (no membrane)- carries a risk of cerebral air emoblism

26
Q

The priming fluid for CBP can be

A

blood or a balanced salt solution (mannitol, albumin, heparin, HCO3-)

27
Q

Hemodilution has the following effects:

A

decreased hematocrit
decreased oxygen-carrying capacity
decreased blood viscosity (good if hypothermia is used)
decreased plasma concentration of drugs and plasma proteins
increased microvascular flow (due to reduced viscosity

28
Q

When is awareness MOST likely to occur during coronary artery bypass graft surgery with CBP?
a. induction of anesthesia
b. aortic cannulation
c. rewarming
d. sternotomy

A

d. sternotomy

29
Q

What ACT is required to start CPB?

A

> 400

30
Q

Systolic BP should be _______________ before aortic cannulation

A

<100

31
Q

What should be used pre-bypass to conserve blood loss?

A

cell saver or antifibrinolytics

32
Q

Cardioplegia is a

A

potassium-containing solution that arrest the heart in diastole

33
Q

The best way to reduce myocardial oxygen consumption during CPB is

A

cardioplegia

34
Q

CPB produces ________________________ that can result in critical organ injury and failure

A

systemic inflammation

35
Q

_________ of protamine reverses 100 units of heparin given

A

1 mg

36
Q

Radial artery pressure may be _____________________________ immediately after CPB

A

artificially low

37
Q

What are common in the post-bypass period?

A

myocardial depression and heart block so vasoactive medications and cardiac pacing may be required

38
Q

Heparin allergy or a history of heparin-induced thrombocytopenia requires

A

an alternative such as bivalirudin, hirudin, or another factor 10 inhibitor

39
Q

Cardioplegia can be administered

A

antegrade, retrograde or both

40
Q

Antegrade cardioplegia is introduced into the

A

aortic root, where the solution enters the coronary arteries

41
Q

Retrograde cardioplegia is administered through a cannula placed in the

A

coronary sinus

42
Q

________________ complicates our interpretation of blood gas results during CPB

A

Hypothermia

43
Q

As temp decreases more ____________ dissolves in the blood and affects __________

A

CO2; pH

44
Q

_____________ does not correct for the patient’s temperature and is associated with better outcomes in adults.

A

Alpha-stat

45
Q

_________ corrects for the patient’s temperature and is associated with better outcomes in peds.

A

pH-stat

46
Q

__________ is when all of the venous return is drained in the venous reservoir, while ______________ describes a situation where the heart receives and pumps a fraction of the venous return

A

Full bypass; partial bypass

47
Q

How does protamine work?

A

neutralization reaction- it forms an acid/base complex with heparin

48
Q

Administering protamine over 10-15 minutes reduces the likelihood of

A

systemic vasodilation as well as pulmonary vasoconstriction
it does not impact the probability of anaphylaxis

49
Q

List 2 antifibrinolytics commonly used during cardiac surgery.

A

TXA
aminocaproic acid

50
Q

What is a contraindication to antegrade cardioplegia?

A

incompetent aortic valve

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