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APEX Flashcards > Cardiac APEX > Flashcards

Cardiac APEX Flashcards

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1
Q

Inotropy
Chronotrophy:
Dromotrophy
Lusitropy

A
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2
Q

Sodium-Potassium ATPase Function

Type of transport:

Whats in and out:

What med inhib?

A

restore resting membrane potential

Active transport:

3 Na+ out., 2 K+ in

**Digoxin= inhib Na/KATPase = positive inotropic

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3
Q
A
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3
Q

3 Phases of SA node action potential??

Ion movement in each?

Action potential pathway:

A
  • Phase 4: spontaneous depolarization of Na+ influx and Ca+2 in T-type
  • Phase 0 = depolarixation
  • Phase 3= Repolarization K+

-SA node -Internodal tracts -AV Node
-Bundle of His Left and right bundle branches
-Purkinje fibers

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4
Q
A
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4
Q

SVR formula

A
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5
Q

MAP formula

A
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6
Q

PVR formula

A
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6
Q

POTASSIUM effect on RMP and TP

Hypokalemia
Hyperkalemia
Severe hyperkalemia

Clinical example??
What can you give for hyperkalemia dysrthymias?

A

Hypo-kalemia
*RMP become more NEGATIVE
*Decreases resting membrane potential
*Cell more resistant to depolarization

Hyper-kalemia
-RMP become more POSITIVE
-HYPERKALEMIA = decreases threshold potential
*Cell depolarize more easily

Severe hyperkalemia:
*Severe hyper-kalemia  Inactivates Na+ channels (they arrest in their closed-inactive state)

K+ containing cardioplegia solution CABG -the heart in diastole
*High K+ concentration does not allow the cells to repolarize, which locks the sodium channel in their closed-inactive state

  • Clinical correlation: Give IV calcium to reduce risk of dysrhythmias in pts with hyperkalemia
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7
Q

CALCIUM effect on RMP and TP

Hypocalcemia
Hyper-calcemia
When does cell depolarize easier with?

Clinical correlation?

A

Hypo-calcemia:
* TP becomes more negative
*Cell depolarizes more easily

Hyper-calemcia:
* TP becomes more positive
*Cell becomes more resistant to depolarization

  • Clinical correlation: Give IV calcium to reduce risk of dysrhythmias in pts with hyperkalemia (it increases gap between RMP and TP)
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8
Q
  • Phase 0= Depolarization
  • Phase 1 = Initial repolarization
  • Phase 2= Plateau Ca+2 influx
  • Phase 3 = Repolarization
  • Phase 4= Maintenance of transmembrane potential (K+ out/ Na+/K-ATP function)
A
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9
Q

^ Preload = ____

Decrease preload = ____

A
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10
Q

The Importance of Atrial kick and Ventricular Compliance:

Atrial kick = ____ of LVEDV/ CO

Conditions associated with reduced myocardial compliance include:

A
  • Atrial contraction (atrial kick)/ “priming the pump” = contributes to 20-30% of the final LVEDV and, by extension, cardiac output.
  • A fib = lost of Atrial kick  Reduce Cardiac output

The non-compliant ventricle is stiff = more dependent on a wall-timed atrial kick

Conditions associated with reduced myocardial compliance include:
* Myocardial hypertrophy
* Fibrosis
* Aging

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11
Q

Factors that increase contractility?

Factors that decrease contractility?

A
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11
Q

Factors that decrease contractility?

A
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12
Q
A
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13
Q

SVR and PVR formula

A
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14
Q

What law to describe ventricular afterload??
What is the formula?

A
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15
Q

Determinants of HR

Firing rates of each???
SA Node/ Keith flack
AV Node Purkinje Fibers
Intrinsic firing rate (BPM)

SNS tone
PNS tone

A

*SA Node: 70-80 (faster in the denervated heart)
*AV Node Purkinje Fibers : 40-60
*Intrinsic firing rate (BPM): 15-40

SNS tone= Cardiac accelerator fibers (T1-T4)
* NE = increases HR by increasing Na+ and Ca+ conductance.
–> This increases the rate of spontaneous phase 4 depolarization.

PNS stimulation (Ach)= slows heart rate by increasing K+ conductance and hyperpolarizing the SA node.

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16
Q

Right vagus innervates ____
Left vagus innervates ____

A
  • Right vagus innervates the SA node,
  • Left vagus innervates AV node
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17
Q

Reference value for each:

Oxygen Carrying Capacity: CaO2

Oxygen Delivery: DO2

Oxygen Extraction Ratio: EO2

Oxygen Consumption (VO2)

Venous oxygen concentration:

A

CaO2 = (Hgb x SaO2 x 1.334) + (PaO2 x0.003)
* Reference value = 20 mL/dL

Oxygen Delivery: DO2
* How much O2 is carried in the blood and how fast it is being delivered to the tissues
* DO2 = CO x [(Hgb x SaO2 x 1.34) + (PaO2 x 0.003)] x 10
* Reference value= 1000mL/min

Oxygen Extraction Ratio: EO2
* How much O2 is extracted by the tissues
* Reference value for whole body = 25% (individual tissue beds will vary)

Oxygen Consumption (VO2)
* Tells us how many O2 is consumed by the tissues
* Reference value = 250 mL/min or 3.5 mL/kg/min

Venous oxygen concentration:
* Tells us how many O2 is carried in venous blood
* Reference value = 15mL/dL

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18
Q
A
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19
Q

^ temp = ___ blood viscosity

Decrease temp = ____ blood viscosity

Increased Hct = ____
Decrased Hct + ____

A
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20
Q

Reynolds number (Re) can be used to predict if flow will be laminar or turbulent.
* Re < 2000: ____
* Re >4000: _____
* Re=2000-4000: ____

Laminar flow-molecules: Parallel path

Turbulent flow—non-linear path and will create eddies

Transitional flow—laminar flow along the vessel walls with turbulent flow in the center

A
  • Re < 2000 predicts that flow will be mostly laminar
  • Re >4000 predicts that flow will be mostly turbulent
  • Re=2000-4000 suggests transitional flow
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20
Changing the radius is the best way to impact flow, because flow is directly proportional to the radius raised to the ___h power Double radius = Flow increases ___fold Tripling radius= flow increases ___ fold Quadrupling radius+ Flow increases ___fold
4th power * Double radius =Flow increases 16 fold * Tripling radius = flow increases 81 fold * Quadrupling radius =Flow increases 256 fold
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Law of Laplace formula? Wall stress is reduced by: (3) - ___ Intraventricular pressure -____ radius -_____ Wall thickness
Wall stress is reduced by: * Decreased intraventricular pressure * Decreased radius * Increased wall thickness Wall stress= Intraventricular pressure x Radius Ventricular thickness
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Ohm's Law
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Risk of Perioperative MI in the Patient with Previous MI: General population = MI if>6months= MI if 3-6 months = MI <3 months = The highest risk of reinfarction is greatest within ____ days
General population = 0.3% MI if>6months=6% MI if 3-6 months = 15% MI <3 months = 30% 30 days of an acute MI. for this reason, the ACC/AHA guidelines recommend a minimum of 4-6 weeks before considering elective surgery in a patient with a recent MI.
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Risk Factors for Perioperative Cardiac Morbidity and Mortality for Non-Cardiac Surgery
* High risk surgery (see below) * History of ischemic heart disease (unstable angina confers the greatest risk of perioperative MI) * History of CHF * History of cerebrovascular disease * Diabetes mellitus * Serum creatinine > 2 mg/dL * Unstable angina is defined as angina at rest, new onset angina (<2 months) , increasing symptoms (intensity, frequency, duration), duration exceeds 30 min, and symptoms have become less responsive to medical therapy.
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Risk Factors for Perioperative Cardiac Morbidity and Mortality for Non-Cardiac Surgery High risk?? Intermediate risk?? Low Risk??
High (Risk > 5%) * Emergency surgery (especially in the elderly) * Open aortic surgery * Peripheral vascular surgery * Long surgical procedures with significant volume shifts and/or blood loss Intermediate (Risk = 1-5%) * Carotid endarterectomy * Head and neck surgery * Intrathoracic or intraperitoneal surgery * Orthopedic surgery * Prostate surgery Low (Risk <1%) * Endoscopic procedure * Cataract surgery * Superficial procedures * Breast surgery
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LV Pressure-volume loop 6 stages??
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How do you calculate EF?
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Stenosis = ___ Hypertrophy Regurg = _____ Hypertrophy
Regurg is eccentric hypertrophy
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What are the hemodynamic goals for Aortic stenosis HR: PL: Contractility SVR PVR
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What are the hemodynamic goals for Mitral stenosis HR: PL: Contractility SVR PVR Most common dysrthymia?
A fib
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What are the hemodynamic goals for Aortic regurg HR: PL: Contractility SVR PVR
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What are the hemodynamic goals for Mitral regurg HR: PL: Contractility SVR PVR
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6 risk factors for perioperative cardiac mortality?
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Cardiac low risk?
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Cardiac high and intermediate risk???
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Cardiac enzyme in suspected ischemic event? CKMB Trop 1 Trop T Initial elevation? Peak elevelation? Return to baseline when?
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How to treat intra op MI How to increase O2 demand How to decrease O2 demand Causes of each? HR, BP, PAOP
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Modified New york Association Functional Classification of Heart failure? Class 1: Class 2: Class 3: Class 4:
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6 complications of HTN
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Difference between primary and seconday HTN? 7 causes of seconday HTN?
Primary essentail = more common and no idenfiable cause (95%)
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Patho of pericarditis
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Patho of pericardial tamponade
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Kussmaul's sign what 2 conditions occur with this condition?
Kussmal associated with pericarditis and pericardial tamponade
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beck's triad?? associated with? and 3 signs
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Pulsus paradoxus? Conditions associated with pulsus paradoxus?
constrictive pericarditis and pericardial tamponade
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Drugs to USE for pericardial tamponade and pericardiocentesis
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Drugs to avoid for pericardial tamponade and pericardiocentesis
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How long should elective surgery be delayed for pt after PCI: Angioplasty without stent: Bare metal stent: Drug eluting stent: CABG:
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Describe the Crawford classification system of aortic aneurysm
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Descrube debakey and stanford classification of aortic aneurysm
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How does preload changes, AL changes, and contractility affect the pressure volume loop?? ^PL? decrease PL? ^AL? decrease AL? ^Contract? decrease contract?
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What does each vessel perfuse?? LCA LAD Circumflex RCA PDA
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Best view for TEE? Myocardial ischemia? 1. ) 2.)
Best view for diagnosing left ventricular ischemia is: Midpapillary muscle level in short-axis Second best view: apical segment also in short-axis
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At rest: coronary blood flow is: ____ % of CO: ___ Coronary blood flow formula: Coronary perfusion pressure formula: *At rest, myocardium consume oxygen at a rate: ______ extraction ratio of: ____ MOST IMPORTANT DETERMINANT of CO2 VESSESL DIAMETER????
* At rest: coronary blood flow is 225 mL/min (4-5% of cardiac output) Coronary blood flow = coronary perfusion pressure/ coronary vascular resistance * Coronary perfusion pressure = Aortic DBP- LVEDP *At rest, myocardium consume oxygen at a rate 8-10 mL/min/100g with an extraction ratio of ~70% ***LOCAL METABOLISM IS THE MOST IMPORTANT DETERMINANT of CO2 VESSESL DIAMETER****
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* Hypocarbia = coronary vasoconstriction or vasodilation
* Hypocarbia = coronary vasoconstriction Endocardial blood vessels of the myocardium
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Effects of Calcium in vascular SM: Increased Ca+2 causes ______ Reduced intracellular Ca+ 2 leads _______
increased Ca+2 causes: vasoconstriction Reduced intracellular Ca+ 2 leads: vasodilation.
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Infective endocarditits that needs antiobiotics and dont
Need antibiotic: * Previous infective endocarditis * Prosthetic heart valve * Unrepaired cyanotic congenital heart disease * Repaired congenital heart defect if repair <6 months old * Repaired congenital heart disease with residual defects that have impaired endothelization at graft site * Heart transplant with valvuloplasty Dont: * Unrepaired cardiac valve disease including mitral valve prolapse * CABG * Coronary stent placement * GI endoscopic procedures without infection * GU procedures without infection * TEE without infection * Dermatologic procedures without infection

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