Cardiac Disorders and 12 Lead EKG Part 3 Flashcards Preview

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Flashcards in Cardiac Disorders and 12 Lead EKG Part 3 Deck (43):
1

What disease is characterized by a blowing murmur heard best along the left sternal border plus peripheral signs of hyperdynamic circulation (widened pulse pressure,decreased diastolic pressure, and bounding peripheral pulses)?

aortic regurgitation

2

What tests confirm severity of aortic regurgitation? (3)

  • Echo
  • Cardiac catheterization
  • CXR & ECG: provides evidence of LV enlargement

 

3

Symptoms of aortic regurgitation appear early on.  True or false?

false

appear in advanced stages

4

Medical therapy of aortic regurgitation is based on decreasing left ventricle afterload by drug induced vasodilation with ______ for acute LV overload and ________ for asymptomatic patients.

nitroprusside

nifedipine

5

Anesthetic considerations for aortic regurgitation: (3)

  • avoid sudden decreases in HR
  • avoid sudden increases in SVR
  • minimize drug-induced myocardial depression

6

What disease is usually functional, reflecting dilation of the right ventricle due to pulmonary HTN?

tricuspid regurgitation

7

What also accompanies tricuspid regurgitation? (2)

  • pulmonary HTN 
  • RV volume overload due to LV failure produced by aortic or mitral valve disease

8

What heart disease is secondary to infective endocarditis and also associated with IV drug abuse?

tricuspid regurgitation

9

Tricuspid regurgitation is also associated with _____ _____ when valve dysfunction is the result of prior rheumatic fever.

tricuspid stenosis

10

Consequence is RA volume overload is usually well tolerated, but when paired with RV volume overload from LV failure or pulmonary HTN, this can lead to ___ ____ failure which can cause ___ atrium pressure to be greater than ___ atrium pressure resulting in left-to-right intracardiac shunt through an incompletely closed foramen ovale.

right ventricle

right

left

11

Anesthetic consideration for tricuspid regurgitation: (5)

  • maintain IV volume 
  • maintain central venous pressures in high normal ranges to facilitate adequate RV stroke volume and left ventricular filling
  • avoid events that increase PVR (arterial hypoxemia and hypercarbia)
  • consider Ketamine since no vasodilation occurs
  • avoid IV infusion of air due to possibility of right-to-left intracardiac shunt through an incompletely closed foramen ovale

12

What condition is this?

BP > 140/90 on at least 2 occasions measured at least 1-2 weeks apart

 

systemic hypertension

13

The following conditions can develop as a result of ____ ______.

  • ischemic heart disease
  • congestive heart failure
  • cerebral vascular accident
  • arterial aneurysm
  • end stage renal disease

systemic hypertension

14

Optimal BP is: ____/_____

Normal BP is less than ____/____

 

120/80

130/85

15

High-normal BP ranges from:

Systolic: ___ - _____

Diastolic: ____ - _____

130-139

85-89

16

Stage 1 Hypertension ranges from:

Systolic: ____-____

Diastolic: _____-____

140 - 159

90  -99

17

Stage 2 Hypertension ranges from:

Systolic: ____-____

Diastolic: _____-____

160 - 179

100 - 109

18

Stage 3 Hypertension BP is ___ / ___

180

110

19

What accounts for 95% of all cases of HTN?

Essential HTN

20

The cause of ____ HTN cannot be identified.

essential

21

Familiar incidence and patholphysiological factors such as:

  • increased sympathetic NS activity
  • overproduction of Na retaining hormones & vasoconstrictors
  • high Na intake
  • increased renin secretion
  • deficiencies of vasodilators

describe ______ hypertension.

 

essential

22

Known etilogy is present in _____ HTN.

secondary

23

What is the most common secondary type of HTN?

Renovascular HTN from renal artery stenosis

24

When renovascular HTN is present, diastolic BP is usually > ____ mmHg and an ____ ____ ___ is present.

125

upper abdominal bruit

25

What test confirms secondary HTN?

MRI

26

What is the treatment of essential HTN?

  • lifestyle modification: weight reduction, increase in physical activity, moderation in alcohol, quit smoking
  • pharmacologic therapy: diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers
  • calcium channel blockers

27

Secondary HTN is treated by: (2)

  • treatment is often surgical (angioplasty, surgery for stenotic renal artery, adrenalectomy)
  • pharmacologic therapy reserved for patients in those where surgery is not possible

28

Hypertensive crisis when acute diastolic BP > _____mmHg.

 

130

29

Need for emergent treatment determined by absolute BP rather than rate of increase.  True or false?

False, 

determined by rate of increase rather than absolute BP

30

Patients with evidence of acute or ongoing target organ damage (encephalopathy, CHF, renal insufficiency, subarachnoid hemmorage) require prompt treatment with ____ BP lowering agents.

IV

31

Don't decrease BP to normotensive levels!

Desired decrease is MAP < ___% in first 2 hours, then additional decreases over next ___-___ hours.

20

24-48

32

Meds to consider delivering during hypertensive crisis: (3)

  • Nitroprusside
  • Hydralazine
  • Nitroglycerine

 

33

Anesthetic considerations for HTN during preop evaluation: (3)

  • determine adequacy of BP control
  • review drugs being administered for BP control
  • evaluate evidence of end-organ damage

34

For HTN patients: induction of anesthesia considerations: (2)

  • anticipate exaggerated BP changes
  • limit duration of DL

35

For HTN patients: maintenance of anesthesia considerations: (2)

  • administer a volatile anesthetic to blunt HTN responses
  • monitor for MI

36

For HTN patients: post-op management considerations (2)

  • anticipate periods of HTN
  • maintain monitoring of end-organ function

37

Condition occurs when the heart is unable to provide sufficient pump action to distribute blood flow to perfuse tissues and organs of the body.

Congestive heart failure

38

What are the causes of CHF? (4)

  • valve abnormalities
  • impaired contractility secondary to ischemic heart disease or cardiomyopathy
  • systemic HTN
  • pulmonary HTN (cor pulmonale)

39

What is the most common form of heart failure?  

Fluid may back up in the lungs causing SOB.

left-sided heart failure

40

What most commonly results from left-sided heart-failure?  

right-sided heart failure

41

Fluid may back up into the abdomen (ascites) and legs and feet (edema) in this type of heart failure.

right-sided heart failure

42

In this type of heart failure, the left ventricle cannot contract vigorously, indicating a pumping problem.

EF < ___% in this case.

systolic

45

43

In this type of heart failure, the left bentricle cannot relax or fill fully, indicating a filling problem from noncompliant ventricles.  

diastolic heart failure