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Anesthesia Made Easy > Cardiac Keywords > Flashcards

Cardiac Keywords Flashcards

1
Q

When viewed on a chest x-ray the correct position of the tip of a CVL via the RIJ is

A

Above the level of the carina

Too high vessel erosion

Too low 11th pericardial reflection which is at the level of the Carina; arrhythmia,coronary sinus and TV damage

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2
Q

Which walls of the LV Do you see on ME four chamber view?

A

Lateral wall and septum

Coronary sinus

This is where you place a retrograde cardioplegic catheter

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3
Q

Which walls of the LV are visible on the ME to chamber view?

A

The anterior and inferior walls

LA appendage is also visible

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4
Q

ME bicaval view

Which Chambers can you see

A

RA and LA

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5
Q

What are you able to focus on on the ME RV inflow outflow view?

A

Aortic valve

The non-coronary cusp lies against the interatrial septum

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6
Q

Which part of the heart does the Vegas nerve innervate

Which neurotransmitter does it use

A

The SA and AV node

Acetylcholine

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7
Q

At which spinal levels are the cardio accelerator fibers found

A

T1 -T4

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8
Q

Name the sympathetic ganglion in the neck abdomen and pelvis

A

Neck stellate ganglion
abdomen celiac plexus mesenteric and hypogastric’s
pelvis ganglion impar

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9
Q

Are white ram I communications pre-or post ganglionic

A

Preganglionic containing Spinal nerves on their way to sympathetic ganglia

Gray rami are postganglionic fibers from the sympathetic to the spot on earth

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10
Q

What is the pathway of the oculocardiac reflex

A

Afferent ciliary nerves to the ciliary ganglion on the gasserian ganglion to brainstem

Efferent via the vagal nerve

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11
Q

Which wavelengths are preferable for penetration

A

Large wavelengths have better penetration while smaller wavelengths a better resolution

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12
Q

I wonder what condition do you have increased stroke volume variation with respiration

A

With low preload

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13
Q

IVC greater than 2cm and no resp variation

A

Elevated CVP

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14
Q

What three factors affect SVO2 (mixed venous oxygen sat)

A

CO
VO2
CaO2 (oxygen content of arterial blood)

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15
Q

What is a normal SVO2 measured at the tip of a PAC?

A

68-77% (PvO2 38-42 mmHg)

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16
Q

Which disease states result in high SVO2 (Mixe venous O2 sat)?

A

Low O2 consumption: cyanide toxicity, hypothermia

High CO: sepsis, L-R shunt, AV fistula, liver disease

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17
Q

Which disease states resulting in decreased mixed venous O2 sat?

A

Low Hb
Increase O2 consumption (fever, shivering)
Low SaO2 (hypoxia, ARDS)
Low CO (MI, CHF, hypovolemia)

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18
Q

What is SVO2 and what does it reflect

A

Percent of oxygen bound to hemoglobin Returning to the right side of the heart
this reflects how much oxygen is left over by the tissues

Central venous/mixed venous

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19
Q

How long do you delay surgery after a BMS vs a DES?

A

BMS: 30d

DES: 365d

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20
Q

Under what circumstances would you discontinue a stent patients antiplatelet regimen?

A

Nonelective surgery

Risk of bleeding is higher than stent thrombosis

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21
Q

When can elective non-cardiac surgery after DES be considered?

A

After 180 days

22
Q

Your patient has a pacemaker and it has three positions for its nomenclature

What do these positions represent?

A

Paced sense response

O-none
A-atrium
V-ventricle
D-dual

23
Q

Response to sensing:
O
T
I

A

O is none
T is triggered
I is inhibited
D is dual (both)

24
Q

What is a magnet likely to convert a pacemaker to

A

VOO asynchronous

25
Q

What does DOO mean?

A

Dual paced
Senses nothing
Responds to nothing

26
Q

Is there Any evidence that anesthetic drugs alter stimulation threshold of pacemakers?

A

No

27
Q

Which factors do alter pacemaker stimulation threshold?

A

Hyper and hypokalemia
Arterial hypoxemia
MI
Catecholamines

28
Q

Which drugs are acceptable to give in the trachea according to ACLS guidelines?

A 
NAVEL
Naloxone
Atropine
Vasopressin no longer indicated
Epinephrine
Lidocaine
29
Q

What is Becks Triad

A

Hypotension
JVD
Distant heart sounds

30
Q

What is Kussmals sign

Pulsus paradoxus?

A

JVD with inspiration

> 10mmHg drop in SBP with inspiration

31
Q

What is the anesthetic treatment of cardiac Tamponade?

A

Fast full tight hard

Keep full
Avoid bradycardia
Avoid high peak airway pressure
Avoid decrease in SVR
Maintain contractility
Consider ketamine 
May need local for subxiphoid or CPB support via femoral
32
Q

Name the two major outcomes of the POISE trial

A

Perioperative administration of PO to beta blocker naïve patient is associated with

Decreased risk of non-fatal MI
Increased risk of stroke and mortality

33
Q

Name the major outcome of the JACC 2013 trial

A

Abrupt with drawl of beta blockers is harmful

Beta blockers should be continued on patients who have been on them

34
Q

Why doesn’t NO dilate SVR?

A

NO binds to Hb forming nitrosylmethemoglobin therefore it does not dilate SVR

35
Q

What are the effects and toxicity of nitrosylmethemoglobin?

A

Rapidly metabolized to methemoglobin

Immunosuppression
Inhibits platelet Adhesion and aggregation
Rebound effect if discontinued causing increased PVR

36
Q

How does nitrogen oxide work?

A

cGMP mediated

Improved V/Q because it selectively goes to well ventilated alveoli

Selectively dilated PVR

Plum HTN and RV failure

37
Q

Three symptoms of carcinoid syndrome

What is the treatment

Name a medication that can exacerbate

A

Flushing diarrhea and bronchoconstriction

Octreotide histamine blockers and ipatropium

Beta blockers

38
Q

What is the effect of carcinoid syndrome on the heart

A

Serotonin induced fibrosis of valvular endocardium

Restrictive cardiomyopathy

Right sided valves TIPS
tricuspid insufficiency pulmonary stenosis

39
Q

Absolute indications to one lung ventilation

A

Protective isolation to prevent contamination or spread of abscess or hemorrhage
Control of ventilation to one lung under circumstances like cutaneous fistula, cyst, or trauma
Lavage
VATS

40
Q

Protamine is given and the patient has a catastrophic rxn.

What are the two possible ways this can manifest?

How would you treat the pt?

A

Anaphylaxis

Catastrophic pulmonary hypertension

Volume, epi, pulmonary vasodilator, antihistamine steroids

41
Q

How does adranergic simulation affect the risk of developing torsades in patients with prolonged qt

A

Increases risk, continue perioperative beta blockers

Correct k or mg

42
Q

Vasopressin MOA

A

Nonadrenergic V1 receptor

Systemic vasoconstriction, less effect on PVR than epi and norepi

No longer indicated in ACLS

43
Q

Compare the efficacy of vasopressin versus epinephrine in the following types of cardiac arrest:

Vfib
PEA
Asystole

A

It is similar in the management of vfib and PEA

it was found superior to epi in patients with asystole

Study on Out of hospital cardiac arrest in 1200 patients, 2004 NEJM

44
Q

Tx of choice in ACE/ARB periop hypotension

A

Vasopressin

Efficacious even in acidosis

45
Q

Which drugs are used for controlled hypotension?

A

NTP (nitroprusside) cGMP/NO releasing, dilates arterioles more than venues

NTG dilates venules(capacitance) more than aa

Alpha blockade (phentolamine, tolazoline, prazocin, doxazosin

Nicardipine

46
Q

What is the pathophysiology behind cyanide toxicity?

A

Inactivates cytochrome oxidase which stops oxidative phosphorylation therefore tissues cannot use O2

Commonly seen in high dose nitroprusside infusion and enclosed fires because of plastic inhalation

47
Q

Patient on NTP presents with tachyphylaxis metabolic acidosis increased lactate and increased MVO2

What is the treatment

A

Cyanide toxicity

Remove source 100% oxygen or hyperbaric
Tx: with the following
Hydroxy cobalamin B12 binds with free cyanide
Sodium thiosulfate
Amyl nitrate converts hemoglobin to met hemoglobin which scavenges free cyanide

Bicarb to correct acidosis

48
Q

Where does one inject for retrograde cardioplegia?

What are the most common indication

A

Coronary sinus

CABG or valve surgery (esp aortic)

Anterograde injects into the aorta with a cross clamp

49
Q

How does aortic crossclamping affect mean arterial pressure and myocardial oxygen demand?

A

Clamp in dues increase in cardiac after leg raises MAP

This increases my patio oxygen and which can lead to LV decompensation and failure

50
Q

What is a myocardial bridge?

A

A portion of a major coronary vessel that runs through the myocardium

I gets thinner during systole on cath

Anesthesia Made Easy (8 decks)

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