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Apex Review > Cardiovascular pathophysiology 6 > Flashcards

Cardiovascular pathophysiology 6 Flashcards

1
Q

_____________ is the most common cause of postoperative death for AAA.

A

Myocardial infarction

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2
Q

The classic triad of AAA rupture consists of

A

hypotension
back pain
pulsatile abdominal mass
only present in 50% of patients

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3
Q

Independent risk factors for AAA include

A

cigarette smoking
male gender
advanced age

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4
Q

___________ correlates with the risk of rupture

A

Diameter of the AAA

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5
Q

What law is applied to aneurysms?

A

law of Laplace

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6
Q

Most aneurysms rupture in the

A

left retroperitoneum

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7
Q

Which factors increase following cross-clamp removal during abdominal aortic aneurysm repair? (select 2)
a. pulmonary vascular resistance
b. venous return
c. total body oxygen consumption
d. coronary blood flow

A

a. pulmonary vascular resistance
c. total body oxygen consumption

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8
Q

Application of aortic cross-clamp creates _______________ by increasing _____________ & shifting a greater proportion of the blood volume _______ to the clamp

A

central hypervolemia; venous return; proximal

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9
Q

How does aortic cross-clamp affect MAP, SVR, and SvO2?

A

increases all of them

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10
Q

Clamping starves distal tissues of

A

oxygen so these cells convert to anaerobic metabolism

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11
Q

____________ are washed into the systemic circulation when the clamp is released

A

Metabolic byproducts

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12
Q

__________ is a minimally invasive approach of correcting an abdominal aortic aneurysm.

A

EVAR

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13
Q

Removal of aortic cross-clamp creates ____________ by restoring venous capacity ad shifting blood to ___________

A

central hypovolemia; the lower body

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14
Q

Compared to open aortic procedures, EVAR has several benefits including

A

shorter operative times
lower rate of transfusion
shorter length-of- stay
reduced morbidity

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15
Q

______________ occurs when the original graft fails to prevent blood from entering the aortic sac

A

An endoleak

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16
Q

The patient’s physiologic response to the aortic cross-clamp is related to 3 factors:

A

location of AoX placement (infrarenal most common)
intravascular volume status
cardiac reserve

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17
Q

With an EVAR, the patient will receive

A

IV contrast dye so complications related to the dye must be considered

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18
Q

Complications of EVAR include

A

activation of the baroreceptor reflex
massive hemorrhage
aortic rupture
cerebral embolism

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19
Q

Occlusion of the artery of Adamkiewicz during thoracic aneurysm repair may result in all of the following EXCEPT:
a. flaccid paralysis of the lower extremities
b. bowel and bladder dysfunction
c. loss of proprioception
d. loss of temperature and pain sensation

A

c. loss of proprioception

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20
Q

The most important radicular artery perfusing the anterior spinal cord in the thoracolumbar region is the

A

artery of Adamkiewicz

21
Q

Interruption of blood flow to the artery of Adamkiewicz can cause

A

ischemia or infarction to the corresponding spinal cord segments

22
Q

An aortic cross-clamp placed above the artery of Adamkiewicz can cause

A

ischemia to the lower portion of the anterior spinal cord

23
Q

Anterior spinal artery syndrome is also known as

A

Beck’s syndrome

24
Q

Symptoms of anterior spinal artery syndrome include

A

flaccid paralysis of the lower extremities
bowel and bladder dysfunction
loss of temperature and pain sensation

25
Q

Anesthetic considerations for aortic surgery include

A

thoracic cross-clamp times <30 minutes
moderate hypothermia (30-32 degrees C)
CSF drainage
MAP ~100 mmHg
avoidance of hyperglycemia
SSEP & MEP monitoring
partial CPB
drugs- corticosteroids, CCBs, and/or mannitol

26
Q

Where does the artery of adamkiewicz originate?

A

typically between T8-12

27
Q

Injury to which spinal tract explains flaccid paralysis of the lower extremities?

A

corticospinal tract

28
Q

Injury to which spinal tract explains loss of pain and temperature sensation?

A

spinothalamic tract

29
Q

What is the BEST monitor of neurologic integrity during carotid endarterectomy?
a. cerebral oximetry
b. awake patient
c. electroencephalography
d. transcranial doppler

A

b. awake patient

30
Q

Patients with carotid stenosis are at higher risk of

A

transient ischemic attacks or stroke

31
Q

In symptomatic patients, CEA significantly reduces stroke risk when the degree of carotid stenosis exceeds

A

70%

32
Q

____________ is a sign of impending stroke.

A

Amaurosis fugax (temporary blindness in one eye)

33
Q

CEA can be performed under

A

regional or general anesthesia

34
Q

_________ is the best method to assess neurologic integrity

A

The awake patient

35
Q

______________ on the day of surgery has been associated with an increased risk of stroke and death.

A

Hyperglycemia (>200 mg/dL)

36
Q

During cross-clamping, how should BP be managed?

A

normal or slightly elevated BP

37
Q

After the cross-clamp is removed, how should BP be managed?

A

keep the SBP under 145 mmHg to reduce the risk of bleeding at the graft site

38
Q

Postoperative considerations of BP include

A

hematoma, RLN injury, labile BP, and stroke (most common embolic)

39
Q

What ACT is desired for carotid artery angioplasty stenting?

A

ACT >250 seconds

40
Q

Balloon inflation with carotid artery angioplasty stenting can activate the

A

baroreceptor reflex leading to bradycardia and hypotension- pretreat with atropine or glyco to attenuate this response

41
Q

Embolic stroke is treated with

A

recombinant tissue plasminogen activator

42
Q

In the patient with right subclavian steal syndrome, arterial flow is diverted from the:
a. right vertebral artery to the right subclavian artery
b. right subclavian artery to the left subclavian artery
c. left vertebral artery to the right subclavian artery
d. left subclavian artery to the right subclavian artery

A

a. right vertebral artery to the right subclavian artery

43
Q

Subclavian steal occurs when

A

there is an occlusion of the subclavian or innominate artery proximal to the origin of the ipsilateral vertebral artery

44
Q

The ___________ is much lower in the ipsilateral arm with subclavian steal syndrome

A

BP- pulse may be diminished

45
Q

The treatment of choice for subclavian steal syndrome is

A

subclavian endarterectomy

46
Q

Signs and symptoms of subclavian steal syndrome include

A

syncope
vertigo
ataxia
hemiplegia
ischemia to the ipsilateral arm
upper extremity weak pulse

47
Q

Is subclavian steal syndrome more common on the left or right side?

A

left side

48
Q

Subclavian steal syndrome “steals” blood from which vessel?

A

vertebral artery

Apex Review (224 decks)

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