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apex review > Cardiovascular pathophysiology 5 > Flashcards

Cardiovascular pathophysiology 5 Flashcards

1
Q

Pick the statements that MOST accurately describe an intra-aortic balloon pump. (select 2)
a. it increases afterload
b. the tip of the balloon should be positioned 2 cm proximal to the brachiocephalic artery
c. it inflates during diastole
d. it is contraindicated in severe aortic insufficiency

A

c. it inflates during diastole
d. it is contraindicated in severe aortic insufficiency

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2
Q

The intra-aortic balloon pump improves

A

the balance between myocardial oxygen supply and demand

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3
Q

Indications of the intra-aortic balloon pump include

A

cardiogenic shock
myocardial infarction
intractable angina
difficult separation from CPB

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4
Q

The intra-aortic balloon inflates during_____________. This augments __________

A

diastole; coronary perfusion

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5
Q

The balloon deflates during _______________. This causes a vacuum-like effect that ______________

A

systole; reduces afterload and reduces left ventricular work

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6
Q

The most common complications of IABP include

A

vascular injury
infection at the insertion site
thrombocytopenia

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7
Q

The balloon can be timed to inflate during

A

every cardiac cycle (1:1) or at some other ratio (1:2, 1:3, etc.) to facilitate weaning

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8
Q

Contraindications to an intra-aortic balloon pump include

A

severe aortic insufficiency
descending aortic disease (aneurysm)
severe peripheral vascular disease
sepsis

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9
Q

How is an intra-aortic balloon pump inserted?

A

through the femoral artery and advanced along the descending aorta

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10
Q

Proper position of the intra-aortic balloon pump is confirmed with

A

CXR, fluoroscopy, or TEE

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11
Q

The tip of the balloon pump should be positioned

A

2 cm distal to the left subclavian artery- more proximal can lead to occlusion of the left common carotid and/or brachiocephalic arteries

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12
Q

Patients on long term IABP therapy require

A

anticoagulation

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13
Q

In the patient with a left ventricular assist device, organ perfusion is LEAST dependent on:
a. preload
b. pump speed
c. afterload
d. inotropy

A

d. inotropy

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14
Q

An LVAD is a mechanical device that

A

unloads the failing heart by pumping blood from the left ventricle to the aorta

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15
Q

An LVAD can be used as a bridge to

A

recovery
transplant
or destination therapy

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16
Q

________ is the most common cause of death with an LVAD.

A

Sepsis

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17
Q

______________ anesthesia is avoided with an LVAD because

A

regional; on anticoagulant medications

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18
Q

Pump flow for an LVAD is highly dependent on

A

adequate LV preload
pump speed (RPMs)
and the pressure gradient across the pump (afterload)

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19
Q

Flow with an LVAD can be

A

pulsatile or non-pulatile

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20
Q

Considerations if blood flow is non-pulsatile.

A

SpO2 & NIBP will be ineffective
consider an arterial line, serial ABGs, and cerebral oximetry

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21
Q

The inflow cannula of a LVAD is inserted into

A

the apex of the left ventricle

22
Q

The presence of the ____________, ______________, or ___________– requires a surgical correction before an LVAD can be placed

A

intracardiac shunt (PFO), aortic insufficiency, or tricuspid regurgitation

23
Q

Mechanical shear stress with an LVAD can cause

A

coagulopathy & platelet dysfunction

24
Q

_________ is common with a LVAD.

A

GI bleeding

25
Q

Optimization of ___________ is critical because an imbalance between _________ and pump speed can lead to complications

A

intravascular volume; preload

26
Q

The combination of low preload and a relatively high pump speed can produce

A

a suction event (LV sucks down) and occludes the inflow cannula

27
Q

Consequences of a suction event include

A

hypotension
ventricular dysrhythmias

28
Q

What is the primary treatment for a “suck down” event?

A

IVF
reduce pump speed

29
Q

The Crawford classification classifies aortic aneurysms into four types based on

A

the aneurysm’s involvement in the thoracic and abdominal aorta

30
Q

What aneurysm types are the most difficult to repair?

A

Crawford type 2 and 3 b/c they involve the thoracic and abdominal aorta

31
Q

Crawford type 2 aneurysms present the most significant

A

perioperative risks including paraplegia and renal failure following surgery

32
Q

The _______ & _____________- classifications classify various aortic dissections

A

DeBakey & Stanford

33
Q

_________ dissection of the _______________ is a surgical emergency

A

Acute dissection of the ascending aorta (DeBakey 1 or 2 or Stanford A)

34
Q

Which valve is often affected with acute dissection of the ascending aorta?

A

aortic valve- aortic insufficiency

35
Q

Type 1 Crawford aortic aneurysm involves

A

all or most of the descending thoracic aorta
and upper only of the abdominal aorta

36
Q

Type 2 Crawford involves

A

all or most of the descending thoracic aorta
most of the abdominal aorta

37
Q

Type 3 Crawford involves

A

lower only of the descending thoracic aorta
most of the abdominal aorta

38
Q

Type 4 Crawford involves

A

none of the descending thoracic aorta
most of the abdominal aorta

39
Q

The Stanford type A is the same as the

A

Debakey Type 1 & 2

40
Q

The DeBakey Type 1 involves a tear in the

A

ascending aorta + dissection along entire aorta

41
Q

The DeBakey Type 2 involves a tear in the

A

ascending aorta + dissection only in ascending aorta

42
Q

The DeBakey Type 3 involves

A

a tear in proximal descending aorta

43
Q

Dissection of the descending aorta is often managed

A

medically (meds for HR, BP, pain) as surgical repair does not always produce a significant benefit

44
Q

Identify the statement that BEST describes perioperative considerations in the patient with an abdominal aortic aneurysm. (select 2)
a. surgical intervention is recommended when the diameter is >5.5 cm
b. Risk of aneurysmal rupture is best described by Poiseuille’s Law
c. it is more common in females
d. back pain and hypotension suggest rupture

A

a. surgical intervention is recommended when the diameter is >5.5 cm
d. back pain and hypotension suggest rupture

45
Q

Independent risk factors for AAA include

A

cigarette smoking
gender (male >female)
advanced age

46
Q

AAA is generally

A

symptomless

47
Q

AAA is most commonly detected as a

A

pulsatile abdominal mass during routine examination

48
Q

What is used to determine the size of a AAA?

A

CT
US
MRI

49
Q

Surgical correction is recommended when the aneurysm exceeds

A

5.5 cm or if it grows more than 0.6-0.8 cm per year

50
Q

The mechanisms for the development of AAA are the

A

destruction of elastin & collagen (primary)
inflammation
endothelial dysfunction
platelet activation
atherosclerosis

apex review (224 decks)

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