Cardiac Midterm

Question 1

What is the ratio in the Na/K pump?

Answer 1

3 Na out and 2 K in

Question 2

What happens during phase 0 on the cardiac action potential?

Answer 2

Na in

Initial upstroke

Question 3

What happens during phase 1 on the cardiac action potential?

Answer 3

K out
Cl in

First downstroke

Question 4

What happens during phase 2 on the cardiac action potential?

Answer 4

K out
Ca in

Flat plateau

Question 5

What happens during phase 3 on the cardiac action potential?

Answer 5

K out

Final downstroke

Question 6

What happens during phase 4 on the cardiac action potential?

Answer 6

Na out

Resting phase. flat line

Question 7

Intrinsic firing rate for each tissue?

Answer 7

SA node 70-80
AV node 40-60
Purkinje fibers 15-40

Question 8

Normal DO2?

Answer 8

1000ml/min

Question 9

Normal CaO2?

Answer 9

20ml/dl

Question 10

Normal extraction ratio?

Answer 10

25%

250mL/min

Question 11

Normal VO2?

Answer 11

250mL/min

Question 12

What determines blood viscosity?

Answer 12

Hct and body temp

Question 12

When is the LV sub endocardium best perfused?

Answer 12

Diastole

Question 13

What percentage of blood goes to the coronaries?

Answer 13

5% or 250ml/min

Question 14

When is the RV sub endocardium best perfused?

Answer 14

Throughout

Question 15

When do most perioperative MIs occur?

Answer 15

24-48 hours post op

Question 16

Steps in the nitric oxide pathway?

Answer 16

L arginine to nitric oxide

2.Nitric oxide activates gmp

3.gmp is converted to cGMP

4.cGMP reduces Ca and leads to relaxation

Question 17

What does S3 signify? Where is it heard?

Answer 17

Heart failure

Just after S2 (gallop or rumble)

Question 18

What does S4 signify?

Answer 18

Atrial systole

Before S1

Question 19

Normal valve orifice for AS?

Answer 19

2.5-3.5cm

Severe is <0.8

Question 20

What is the triad for AS?

Answer 20

SAD

Syncope
Angina
Dyspnea

Question 21

Anesthetic management for AS?

Answer 21

1. Preload - Increase
2. HR - 75 and NSR
3. SVR- Maintain or increase

AVOID spinal

Question 22

Most common cause of AS?

Answer 22

Calcification

Rheumatic fever
Endocarditis

Question 23

Normal mitral valve orifice?

Answer 23

5cm

-Severe <1
-Pressure gradient exceeds 10
-PA greater than 50

Question 24

Most common cause of MS?

Answer 24

Endocarditis in USA Rheumatic fever in world

Question 25

Management of MS?

Answer 25

1. Preload - Maintain 2. HR - 75 and NSR 3. SVR- Maintain AVOID increase PVR AVOID spinal

Question 26

Management of Mitral regurgitation

Answer 26

HR - Increase Preload- Maintain Afterload - Decrease Avoid increase in PVR Okay for regional

Question 27

What to avoid with mitral valve conditions?

Answer 27

Increase in PVR

Question 28

What is a risk after a mitral valve repair? ****

Answer 28

SAM - systolic anterior motion Treat wit fluids and increasing afterload

Question 29

Treatment of aortic regurgitation?

Answer 29

Full, Fast, Foward

Question 30

Murmurs - AS?

Answer 30

ASSS Aortic Stenosis Systole Sternal border (R)

Question 31

Murmurs - Aortic regurg?

Answer 31

ARDS Aortic Regurgitation Diastole Sternal border (R)

Question 32

Murmurs - MS?

Answer 32

MSDA Mitral Stenosis Diastole Apex and L Axilla

Question 33

Murmurs - Mitral regurgitation ?

Answer 33

MRSA Mitral Regurgitation Systole Apex and L Axilla

Question 34

When is the highest likelihood of reinfarction of an MI?

Answer 34

Within 30 days

Question 35

HF classification system?

Answer 35

1-Asymptomatic 2 Symptomatic with moderate exercise 3 Symptomatic with mild exercise 4 Symptoms at rest

Question 36

How to treat an MI?

Answer 36

Slower Smaller Better perfused

Question 37

Better biomarkers, troponin or CK-MB?

Answer 37

Troponin Peak in 24 hours and returns to baseline in 10 days

Question 38

How long after an MI will you see an increase in cardiac biomarkers?

Answer 38

3-12 hours

Question 39

What is the most common cause of R heart failure?

Answer 39

l heart failure

Question 40

How does nitrous affect PVR?

Answer 40

INCREASES

Question 41

What increases PVR?

Answer 41

Hypoxia Hypercarbia Acidosis

Question 42

What BP is considered a hypertensive crisis?

Answer 42

>180/120

Question 43

What is Kussmauls Sign?

Answer 43

*Constrictive pericarditis Increased CVP during inspiration JVF

Question 44

What to avoid in Pericarditis?

Answer 44

Bradycardia

Question 45

What is Becks Triad?

Answer 45

Cardiac Tamponade Hypotension JVD Muffled heart tones

Question 46

Anesthetic management of Cardiac tamponade?

Answer 46

Local anesthetic **Maintain spontaneous ventilation ++Ketamine Maintain or increase all parameters

Question 47

When is antibiotic prophylaxis not required for endocarditis?

Answer 47

Stent CABG Unrepaired valve GI or GU procedures

Question 48

Treatment for HOCUM?

Answer 48

Preload- Increase Contractility - Decrease HR - Decrease Afterload - Increase

Question 49

Stent recommendations?

Answer 49

No stent - 4 weeks Bare metal - 6 weeks Drug eluting - 1 year CABG - 6 weeks

Question 49

When should aspirin be stopped ?

Answer 49

3 days

Question 50

When should Plavix be stopped?

Answer 50

7 days

Question 51

When should Ticlopidine be stopped?

Answer 51

14 days

Question 52

Goal for PCI timeline?

Answer 52

<90 minutes

Question 53

What can be given to reverse platelet inhibition?

Answer 53

Platelets

Question 54

What type of CPB is preferred? Why?

Answer 54

Centrifugal - less traumatic to blood cells *reduced risk of air

Question 55

What should the ACT be before going on pump?

Answer 55

>400 seconds

Question 56

General rule for protamine dose?

Answer 56

1mg per 100 units

Question 57

When is surgical intervention recommended for a AAA?

Answer 57

>5.5 cm

Question 58

Triad of a AAA?

Answer 58

Back pain Hypotension Pulsatile abdominal mass

Question 59

What is the artery of Adamkiewicz?

Answer 59

Most important radicular artery Perfuses anterior spinal cord

Question 60

What is maintained during anterior spinal artery syndrome?

Answer 60

Touch and proprioception

Question 61

What is subclavian steal syndrome ?

Answer 61

Occurs on the left side Diverts blood away from brain to ipsilateral side

Question 62

What increases contractility?

Answer 62

Chemicals and Calcium

Question 63

What law can describe afterload?

Answer 63

Law of LaPlace

Question 64

Which two conditions set the afterload?

Answer 64

AS Coarctation of the aorta

Question 65

What is the best TEE view for diagnosing MI?

Answer 65

Midpapillary level on short axis

Question 66

How does cGMP affect Ca???? ***

Answer 66

Reduces calcium

Question 67

Most common dysrhythmia with MS?

Answer 67

Afib

Question 68

Six factors for increased morbidity and mortality?

Answer 68

-High risk surgery -History of ischemic heart disease -History of CHF -History of cerebrovascular disease -DM -Creatine >2

Question 69

Which HF has a preserved ejection fraction? What is the issue?

Answer 69

-Systolic -Ventricle doesn't empty well

Question 70

Which HF has a preserved EF?

Answer 70

Diastolic Issue is the ventricle is not filling

Question 71

What is the difference between primary and secondary HTN?

Answer 71

Primary - unable to find a cause Secondary - Caused by some other pathology

Question 72

*****Key sign of pulsus paradoxus?

Answer 72

SBP drops by 10 or more points on inspiration

Question 73

What drugs are okay in cardiac tamponade?