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Principles semester 2 > Cardiac Overview > Flashcards

Cardiac Overview Flashcards

1
Q

c wave

A

back flow of blood from ventricles against closed valve

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2
Q

a wave

A

atrial contraction

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3
Q

V wave

A

end of systole, filling of atria

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4
Q

EDV normal volume

A

120 mL

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5
Q

ESV normal volume

A

50 mL

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6
Q

EDV-ESV = ?

A

stroke volume

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7
Q

stroke volume normal

A

70 mL

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8
Q

EF calculation

A

SV/EDV

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9
Q

normal EF

A

60%

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10
Q

Left main coronary circulation

A

LAD, circ, diagonal

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11
Q

2 main coronary circulation

A

Left main and RCA

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12
Q

Coronary venous drainage

A
  1. coronary sinus
  2. anterior cardiac veins
  3. thesbian
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13
Q

External work =

A

SV x pressure

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14
Q

area in cardiac loop is

A

external work

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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)

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16
Q

Kinetic work is

A

kinetic energy of blood flow

L side = right side

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17
Q

What affects inotropy? (2)

A
  1. SNS stim
  2. increase in calcium–>increase flow of calcium through slow calcium channels–> increase force of contraction
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18
Q

EKG is the

A

sum of all ELECTRICAL activity in the heart

reflects excitation NOT contraction

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19
Q

Best lead for rythym problems

A

Lead II (RCA and P wave/dysrhythmias

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20
Q

best lead for ischemia

A

v5

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21
Q

Three basic principles of circulatory system

A
  1. blood is directed to tissues that need flow
  2. increased venous return from circulation resuts in more CO
  3. extensive mechanisms to control BP
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22
Q

1 mm Hg = ______ cm H2O

A

1 mmHg = 1.36 cm H2O

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23
Q

up to _____ of deaths occuing after non-cardiac surgery are related to cardiovascular comlications

A

50%

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24
Q

5 common complications with known CV disease

A
  1. MI
  2. pulmonary edema
  3. CHF
  4. Dysrhythmias
  5. thromboembolism
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25
Q

Risk of perioperative MI for general public

A

0.1-0.7%

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26
Q

Risk of MI if MI within last 6 months

A

6%

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27
Q

Risk of MI within 3-6 motns

A

15%

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28
Q

Risk of MI within 3 moths

A

30%

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29
Q

Goldman cardiac risk basic

A

more points = higher risk of complications

0 risk factors 0.5%, 2 risk factors 9%

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30
Q

functional capacity/status measurements

A

METS (Ideally want >4)

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31
Q

What meds should be continued on day of surgery

A
  1. beta blockers
  2. nitrates
  3. calcium channel blockers
  4. ACE inhibitors
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32
Q

Volatiles and myocardial depression

A

in normal function, volatiles cause myocardial depression

33
Q

Best anesthetc plan for impaired cardiac function

A

high dose fentanyl

34
Q

Regional impaired haert

A

prevent/treat drop in BP with ephedrine/phenylephrine andfluid to maintain CPP

35
Q

Phenylepherine, afterload and oxygen requirements

A

phenyl increases afterload and oxygen requirements

36
Q

Ephedrine, HR and oxygen requirements

A

Ephedrine increases HR and oxygen requirements

37
Q

balance in regional with BP and O2 requirements

A

give enough to maintain BP but not too much that O2 requirements are too hight

38
Q

what volatile causes coronary steal?

A

isoflurane

39
Q

Which paralytics (NMBs) have benign circulatory effects?

A

Vec
Roc

40
Q

paralyticcs/ NMBs that do not have histamine (lower BP)

A

Vec
Roc
Cisatracurium

41
Q

Most common CV disease

A

HTN
33% of population have it and 33% of them don’t know they have it

42
Q

drug of choice for tx hypertensive cirsis

A

nitropursside

43
Q

NY heart association clasifcation class I

A

asymptomaticN

44
Q

NY heart associateion classification class II

A

symptoms with ordinary activity but comfortale at rest

45
Q

NY heart association clssification clas III

A

Symptoms with minimal activity but comoftable at rest

46
Q

NY heart associated classification cla IV

A

symptoms at rest

47
Q

severe AS has transvalvular pressure gradient of

A

> 50mmHg

48
Q

Severe AS has aortic valve orfice of

A

< 1 cm

(normal is 2.5 -3.5 cm)

49
Q

In anesthesia management and AS avoid

A
  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
  5. Optimize fluid volume (maintain venous return and LV filling)
50
Q

in AS, should have_____in the room

A

defibrillator d/t ineffective chest compressions

51
Q

For induction in AS _____ is preferred

A

general anesthesia

avoid succs if possible (induces bradycardia)
use anticholinergic if succs is needed

52
Q

for AS we want:

A

NSR
slower HR
Full preload
maintain BP and CO at all times

think slow, full, forward

53
Q

WIth severe AS, avoid ____(anesthesia type)

A

regional anesthesia

hypotension needs to be avoided

54
Q

what HR do we want in AS

A

< 80 NSR (SLOW)

55
Q

with AS, need adequate

A

preload (FULL)

56
Q

Anesthesia management of AI

A

Fast, Full, Forward

Maintain forward stroke volume
Maintain aortic diastolic pressure
Maintain coronary perfusion pressure

57
Q

FORWARD need with AS

A

Maintain BP and contractility at all times

58
Q

AI HR

A

sinus tachycardia (want higher preload because thats what body is used to)

59
Q

AI “full”

A

Preload

60
Q

what can anesthesia do to maintain AI “forward”

A

Vasoconstriction and inotropic agents

61
Q

in AI avoid:

A
  1. decreased HR
  2. Increased SVR
  3. myocardial depressino
62
Q

biggest risk from mitral stenosis

A

1/3 patients develop atrial fibrillation = increased incidence of PE

63
Q

Mitral stenosis SVR

A

PREVENT decrease in SVR

64
Q

Regional MS (mitral stenosis) considerations

A

Epidrual>spinal

65
Q

For induction with Mitral regurg

A

general anesthesia is preffered

66
Q

1st letter in pacemaker setting is

A

chamber paced

67
Q

2nd letter in pacemaker setting is

A

chamber sensed

68
Q

3rd letter in pacemaker setting is

A

mode of activity

69
Q

4th letter in pacemaker setting is

A

programmability

70
Q

5th letter of pacemaker setting is

A

defibrillator

71
Q

How to convert pacemaker to asynchronous mode

A

magnet over patient’s pacemeaker

72
Q

Beck’s triad

A

cardiac tamponade!
1. hypotension
2. JVD
3. DIstant muffled heart tones

73
Q

Cardiac tamponade maintanace

A

high sympathetic tone

74
Q
A

Aortic stenosis

volume doesnt change much, pressure in LV significatinly increases with contraction

75
Q
A

Aortic regurg

Volume is much higher throughout

76
Q
A

Mitral stenosis

overall less volume

77
Q
A

mitral regurg

Overall blunted pressure change, large volume breadth

78
Q
A

IHHS
aka
Idiopathic Hypertrophic Subaortic stenosis

or hyertrophic cardiomyopathy

79
Q
A

Tamponade

Principles semester 2 (17 decks)

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