Cardiac Overview Flashcards
1
Q
c wave
A
back flow of blood from ventricles against closed valve
2
Q
a wave
A
atrial contraction
3
Q
V wave
A
end of systole, filling of atria
4
Q
EDV normal volume
A
120 mL
5
Q
ESV normal volume
A
50 mL
6
Q
EDV-ESV = ?
A
stroke volume
7
Q
stroke volume normal
A
70 mL
8
Q
EF calculation
A
SV/EDV
9
Q
normal EF
A
60%
10
Q
Left main coronary circulation
A
LAD, circ, diagonal
11
Q
2 main coronary circulation
A
Left main and RCA
12
Q
Coronary venous drainage
A
- coronary sinus
- anterior cardiac veins
- thesbian
13
Q
External work =
A
SV x pressure
14
Q
area in cardiac loop is
A
external work
15
Q
Left heart vs right heart
A
left does 5-6 x work of the right because it is pumping against 5-6 times more pressure (L heart is more muscular)
16
Q
Kinetic work is
A
kinetic energy of blood flow
L side = right side
17
Q
What affects inotropy? (2)
A
- SNS stim
- increase in calcium–>increase flow of calcium through slow calcium channels–> increase force of contraction
18
Q
EKG is the
A
sum of all ELECTRICAL activity in the heart
reflects excitation NOT contraction
19
Q
Best lead for rythym problems
A
Lead II (RCA and P wave/dysrhythmias
20
Q
best lead for ischemia
A
v5
21
Q
Three basic principles of circulatory system
A
- blood is directed to tissues that need flow
- increased venous return from circulation resuts in more CO
- extensive mechanisms to control BP
22
Q
1 mm Hg = ______ cm H2O
A
1 mmHg = 1.36 cm H2O
23
Q
up to _____ of deaths occuing after non-cardiac surgery are related to cardiovascular comlications
A
50%
24
Q
5 common complications with known CV disease
A
- MI
- pulmonary edema
- CHF
- Dysrhythmias
- thromboembolism
25
Risk of perioperative MI for general public
0.1-0.7%
26
Risk of MI if MI within last 6 months
6%
27
Risk of MI within 3-6 motns
15%
28
Risk of MI within 3 moths
30%
29
Goldman cardiac risk basic
more points = higher risk of complications
0 risk factors 0.5%, 2 risk factors 9%
30
functional capacity/status measurements
METS (Ideally want >4)
31
What meds should be continued on day of surgery
1. beta blockers
2. nitrates
3. calcium channel blockers
4. ACE inhibitors
32
Volatiles and myocardial depression
in normal function, volatiles cause myocardial depression
33
Best anesthetc plan for impaired cardiac function
high dose fentanyl
34
Regional impaired haert
prevent/treat drop in BP with ephedrine/phenylephrine andfluid to maintain CPP
35
Phenylepherine, afterload and oxygen requirements
phenyl increases afterload and oxygen requirements
36
Ephedrine, HR and oxygen requirements
Ephedrine increases HR and oxygen requirements
37
balance in regional with BP and O2 requirements
give enough to maintain BP but not too much that O2 requirements are too hight
38
what volatile causes coronary steal?
isoflurane
39
Which paralytics (NMBs) have benign circulatory effects?
Vec
Roc
40
paralyticcs/ NMBs that do not have histamine (lower BP)
Vec
Roc
Cisatracurium
41
Most common CV disease
HTN
33% of population have it and 33% of them don't know they have it
42
drug of choice for tx hypertensive cirsis
nitropursside
43
NY heart association clasifcation class I
asymptomaticN
44
NY heart associateion classification class II
symptoms with ordinary activity but comfortale at rest
45
NY heart association clssification clas III
Symptoms with minimal activity but comoftable at rest
46
NY heart associated classification cla IV
symptoms at rest
47
severe AS has transvalvular pressure gradient of
>50mmHg
48
Severe AS has aortic valve orfice of
< 1 cm
(normal is 2.5 -3.5 cm)
49
In anesthesia management and AS avoid
1. avoid decrease in CO
2. maintain sinus rythm (need atrial kick)
3. avoid bradycardia and tachycardia
4. Avoid sudden changes in SVR and CPP
4. Optimize fluid volume (maintain venous return and LV filling)
50
in AS, should have_____in the room
defibrillator d/t ineffective chest compressions
51
For induction in AS _____ is preferred
general anesthesia
avoid succs if possible (induces bradycardia)
use anticholinergic if succs is needed
52
for AS we want:
NSR
slower HR
Full preload
maintain BP and CO at all times
think slow, full, forward
53
WIth severe AS, avoid ____(anesthesia type)
regional anesthesia
hypotension needs to be avoided
54
what HR do we want in AS
< 80 NSR (SLOW)
55
with AS, need adequate
preload (FULL)
56
Anesthesia management of AI
Fast, Full, Forward
Maintain forward stroke volume
Maintain aortic diastolic pressure
Maintain coronary perfusion pressure
57
FORWARD need with AS
Maintain BP and contractility at all times
58
AI HR
sinus tachycardia (want higher preload because thats what body is used to)
59
AI "full"
Preload
60
what can anesthesia do to maintain AI "forward"
Vasoconstriction and inotropic agents
61
in AI avoid:
1. decreased HR
2. Increased SVR
3. myocardial depressino
62
biggest risk from mitral stenosis
1/3 patients develop atrial fibrillation = increased incidence of PE
63
Mitral stenosis SVR
PREVENT decrease in SVR
64
Regional MS (mitral stenosis) considerations
Epidrual>spinal
65
For induction with Mitral regurg
general anesthesia is preffered
66
1st letter in pacemaker setting is
chamber paced
67
2nd letter in pacemaker setting is
chamber sensed
68
3rd letter in pacemaker setting is
mode of activity
69
4th letter in pacemaker setting is
programmability
70
5th letter of pacemaker setting is
defibrillator
71
How to convert pacemaker to asynchronous mode
magnet over patient's pacemeaker
72
Beck's triad
cardiac tamponade!
1. hypotension
2. JVD
3. DIstant muffled heart tones
73
Cardiac tamponade maintanace
high sympathetic tone
74
Aortic stenosis
volume doesnt change much, pressure in LV significatinly increases with contraction
75
Aortic regurg
Volume is much higher throughout
76
Mitral stenosis
overall less volume
77
mitral regurg
Overall blunted pressure change, large volume breadth
78
IHHS
aka
Idiopathic Hypertrophic Subaortic stenosis
or hyertrophic cardiomyopathy
79
Tamponade
