5. Pulm HTN

Question 1

the heart is

Answer 1

a double pump

Question 2

pulm HTN is defined as

Answer 2

mPAP > 20 mmHg

Question 3

3 types of pulm HTN

Answer 3

precapillary
postcapillary
pre and postcapillary

Question 4

precapillary HTN

Answer 4

pulm artery HTN
CTEPH
lung disease
thromboembolic disease

Question 5

postcapillary HTN

Answer 5

LH disease

Question 6

what other variable determine pulm HTN

Answer 6

pulm arterial wedge pressure
pulm vascular resistance

Question 7

ways to diagnosis pulm HTN

Answer 7

TEE
TTE
Right Heart catheterization

Question 8

most accurate way to diagnose pulm HTN

Answer 8

right heart cath

Question 9

PCWP in pulm HTN

Answer 9

<15mmHg

Question 10

safest way to diagnose pulm HTN

Answer 10

TEE or TTE

Question 11

PASP: mild pulm HTN

Answer 11

36-49 mmHg

Question 12

PASP: mod

Answer 12

50-59 mmHg

Question 13

PASP: severe

Answer 13

> 60 mmHg

Question 14

mPAP

Answer 14

> 20 mmHg

Question 15

PAWP

Answer 15

> 15 mmHg

Question 16

PVR

Answer 16

> 3 WU

(240 dynes/s/cm5)

Question 17

what increase pulm HTN

Answer 17

arterial resistance
venous resistance
incr flow
- incr RH CO
- L to R shunt

Question 18

PVR equation

Answer 18

PVR = (mPAP - PWCP)/CO

Question 19

1 WU

Answer 19

80 dynes/s/cm5

Question 20

5 classifications of PHTN

Answer 20

isolated PHTN
PHTN 2/2 LH disease
PHTN 2/2 lung
CTEPH
PHTN unclear etiology

Question 21

CTEPH

Answer 21

chronic thromboembolic PHTN

Question 22

progressed PHTN results in

Answer 22

cardiac remodelling

Question 23

advanced PHTN characteristics

Answer 23

RV hypertrophy
decr CPP
RAD
RA dysrhtmias

Question 24

PHTN treatment

Answer 24

lifestyle changes
prostanoids
endothelin-R antagonist
NO

Question 25

prostanoids

Answer 25

vasodilation inhibit plt aggregation

Question 26

prostanoids drugs

Answer 26

epoprostenol iloprost treprotsinil beroprost

Question 27

which prostanoids are given by IV

Answer 27

epoprostenol treporstinil

Question 28

endothelin-R antagoist

Answer 28

blocks vasoconstriction == incr vasodilation

Question 29

Endothelin-R antagonist drugs

Answer 29

bosentan ambristentan macitentan

Question 30

NO

Answer 30

cGMP formation incr vasodilation

Question 31

PDE5 inhibitor

Answer 31

soldenafil tadalfil

Question 32

what incr PHTN

Answer 32

venous embolism incr CVP incr airway pressure HPV decr lung volumes incr inflammatory states

Question 33

why does PHTN have high risk of perioperative mortality

Answer 33

large blood loss risk large fluid shifts

Question 34

when should you conduct a diagnoist test for PHTN

Answer 34

mod or severe PHTN screening ansers

Question 35

what therapy is beneficial before PHTN surgery

Answer 35

CCB therapy

Question 36

when is inhaled NO test positive

Answer 36

decr 10 mmHg w/ baseline > 40mmHg

Question 37

what makes you suspricious of PHTN

Answer 37

Sob on exertion hemoptysis jugular distension edema

Question 38

main pathologica issues of PHTN

Answer 38

right ventricular hypertrophy decr R wave amplitude from V1-V4 Right atrial dilation lg P wave in 2, 3, aVF leads

Question 39

intraoperative manaagement for PHTN

Answer 39

mx LH preload: incr venous flow (fluids) incr contractility avoid hypoxia avoid hypercarbia

Question 40

what things cause incr in pulm vasoconstriciton

Answer 40

transient hypotension high PEEP high PIP hypercarbia hypoxia IV bubbles trendelenburg pneumoperitoneum single lung ventilation

Question 41

what Ph is deleterious

Answer 41

< 7.0

Question 42

what decr inotorpy

Answer 42

modern anesthetics

Question 43

what is a negative inotrope

Answer 43

acidosis

Question 44

what drug is best for RHF

Answer 44

milrinone

Question 45

what drugs should we give for RV inotropy

Answer 45

NE phenylephrine epi vasopressing Dopa dobutamine milrinone

Question 46

which inotropes have arrythmia risk

Answer 46

dopamine dobutamine milrinone

Question 47

which drug has improved PA/RV coupling

Answer 47

NE

Question 48

which drug has greater O2 delivery

Answer 48

NE

Question 49

which drugs incr PVR

Answer 49

NE phenylephrine epi vasopressin

Question 50

which drug has reflex brady

Answer 50

phenylephrine

Question 51

which drug increases catecholamine sensitivity

Answer 51

vasopressin

Question 52

what should you think when you hear "RV afterload"

Answer 52

PVR (incr workload)

Question 53

how can you reduce RV afterload

Answer 53

decr PEE decr PIP decr PVR

Question 54

how do you decr PVR

Answer 54

avoid hypoxia avoid hypercarbia avoid atelectasis

Question 55

myocardial supply/demand

Answer 55

incr RV wall tension incr RV EDV incr RV work/O2 demand decr RV CPP decr RV CO decr LV preload decr LV CO decr hypotension decr RV CPP decr RV CO decr LV preload decr LV CO and LV BP

Question 56

ultimate ramification

Answer 56

cardiac death

Question 57

how do you avoid hypoxia

Answer 57

100% FiO2 recruit alveoli

Question 58

how do you avoid acidosis

Answer 58

mx MV

Question 59

how do you mx CO

Answer 59

sympathomimetics milrinone inhaled NO

Question 60

how do you avoid incr intrathoracic pressures

Answer 60

avoid laparaoscopu avoid trendelenberg avoid mechanical vent

Question 61

what can drop systemic BP during labor

Answer 61

pushing incr PVR

Question 62

why is a regional w/sedation dangerous

Answer 62

hypoxia and/or hyperarbia

Question 63

why is enuraxial dangerous

Answer 63

sympathectomy

Question 64

laparoscopy considerations

Answer 64

CO2 induces acidosis incr PIP decr CO

Question 65

thoracic surgery consideration

Answer 65

one lung ventilation

Question 66

one lung ventilation causes

Answer 66

incr RV afterload hypoxia hypercarbia

Question 67

one lung ventilation tratment

Answer 67

inhaled NO