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Anesthesiology Advanced TL > Cardiology > Flashcards

Cardiology Flashcards

(68 cards)

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1
Q

What is the most appropriate circulatory assist device for a patient in end stage heart failure?

A

Left ventricular assist device

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2
Q

What are the hemodynamic goals of anesthetic management of aortic stenosis?

A
  • Increased preload
  • Increased afterload
  • Normal sinus rhythm
  • Avoid hypotension, tachycardia, and significant bradycardia
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3
Q

What is the transvalvular pressure gradient characteristic of aortic stenosis?

A

> 40

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4
Q

What is the valve area characteristic of aortic stenosis?

A

< 1

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5
Q

Sudden changes in oxygen saturation and peak inspiratory pressure during thoracic surgery point to?

A

Pneumothorax

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6
Q

What are the signs of pneumothorax?

A
  • Difficulty with ventilation/respiratory distress
  • Desaturation
  • Hypotension
  • Heart rate changes
  • Unilateral chest rise
  • Distended neck veins/increased CVP
  • Tracheal deviation (late sign)
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7
Q

What is the management of choice for pneumothorax?

A

Rapid re-expansion of lung with chest tube placement

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8
Q

What are the components of hypovolemic shock?

A
  • Decreased cardiac output/index
  • Decreased pulmonary capillary wedge pressure
  • Decreased central venous pressure
  • Increased systemic vascular resistance
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9
Q

What artery supplies the anterior wall of the left ventricle?

A

Left anterior descending artery

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10
Q

What blood pressure range should be targeted when cross-clamping the carotid artery during endarterectomy?

A

High-normal range up to 20% above baseline

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11
Q

What contributes to ST depressions seen after cross-clamp in abdominal aortic aneurysm?

A
  • Increased oxygen myocardial consumption
  • Increased afterload
  • Increased wall stress
  • Increased myocardial contractility
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12
Q

What is the phenomenon of ultrasound transducers converting ultrasound waves into electrical currents?

A

Direct piezoelectric effect

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13
Q

What is the best echocardiographic measure of right ventricular systolic function?

A

Tricuspid annular plane systolic excursion (TAPSE)

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14
Q

Which walls of the left ventricle does the mid esophageal two chamber view show?

A
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15
Q

How to best optimize defibrillation?

A
  • Quick defibrillation
  • Use of electrode gel
  • Lower energy biphasic defibrillation
  • Larger electrodes (8-12 cm)
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16
Q

What is Brugada syndrome characterized by?

A
  • Defect in myocardial sodium channel
  • Pseudo right bundle branch block
  • ST elevation in V1-V3
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17
Q

What are the perioperative considerations for Brugada syndrome?

A
  • Avoid sodium channel blocking drugs
  • Maintenance of normothermia and normokalemia
  • Close EKG monitoring with resuscitation equipment readily available
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18
Q

In which comorbidities would retrograde cardioplegia be preferred over antegrade cardioplegia?

A
  • Diffuse obstructive coronary artery disease
  • Aortic insufficiency
  • Procedures involving manipulation of the aortic root
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19
Q

What scenario is associated with moderate dilation of right and left ventricles, mild global biventricular hypokinesis, and decreased ejection fraction?

A

Sepsis

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20
Q

What are the aortic valve cusps seen in the midesophageal aortic valve short axis view?

A
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21
Q

What is the treatment for heparin resistance?

A
  • Antithrombin III
  • Fresh frozen plasma (FFP)
  • More heparin
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22
Q

What is the standard dose of heparin for cardiopulmonary bypass?

A

400 U/kg

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23
Q

What is the advantage of cannulating the right axillary artery for the arterial line of CPB in arch resection?

A

Ability to perfuse the brain during hypothermic circulatory arrest

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24
Q

What is cardiac resynchronization therapy (CRT) indicated for?

A
  • Left ejection fraction < 35%
  • Sinus rhythm
  • LBBB
  • QRS > 150
  • NYHA class II-IV
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25
What is the most likely source of air embolism from a conventional CPB machine?
Occlusion of the outflow ports in the oxygenator
26
What are the TEE findings associated with pulmonary embolism?
* McConnell's sign * 60/60 sign * Increased PVR and estimated PA pressures * Enlarged RA/RV/IVC/coronary sinus/hepatic veins
27
Which medications used to lower blood pressure would also increase ICP?
* Nitroglycerin * Nitroprusside
28
What is adenosine used for?
Stable supraventricular tachycardia
29
What is the treatment for unstable SVT?
Synchronized cardioversion
30
What are the hemodynamics of end stage liver disease?
* Hyperdynamic circulation * High cardiac output * Low SVR * Low arterial blood pressure
31
What are the factors that increase myocardial oxygen demand?
* Increased myocardial wall stress * Increased mass of myocardial tissue * Increased heart rate
32
What types of myocardial ischemia and infarction exist?
* Unstable angina * Non-ST elevation MI (NSTEMI) * ST elevation MI (STEMI)
33
What is the first treatment for symptomatic bradycardia?
IV atropine
34
What is AV sequential pacing?
Results in 10-50% improvement in cardiac output compared with ventricular pacing alone
35
What is the best induction agent for a patient undergoing ECT with preexisting CAD?
Etomidate
36
Which test is commonly used during heparin administration to evaluate the coagulation system intraoperatively?
Activated clotting time (ACT)
37
How are chest compressions assessed during CPR?
Chest compressions should improve if ETCO2 < 10 or DBP < 20
38
What is an early and classic sign of hyperkalemia on EKG?
Peaked T waves
39
How does furosemide improve symptoms of CHF?
Reduces cardiac filling pressures
40
What are absolute contraindications to TEE probe placement?
* Perforation * Esophageal stricture * Masses * Diverticulum * Active bleeding
41
What hemodynamic changes are seen in laparoscopic surgery?
* Decreased preload * Increased afterload * Decreased cerebral venous return * Increased intracranial pressure
42
What drug is the gold standard for perioperative DVTs and PE?
Low molecular weight heparin
43
What is the most common primary cardiac tumor?
Cardiac myxoma
44
What can cardiac tumors cause?
* Arrhythmias * Ventricular obstruction * Heart failure * Pulmonary edema * Pulmonary hypertension * Arterial hypoxemia * Dyspnea * Positional hemodynamic compromise * Embolism
45
What is atrioventricular (AV) dissociation in CVP tracing characterized by?
Cannon A waves
46
What is the EKG finding of Wolff-Parkinson-White syndrome?
Accessory AV pathway (Bundle of Kent)
47
What EKG findings are associated with Brugada syndrome?
* Pseudo right bundle branch block * ST elevations in V1-V3
48
How should new onset atrial fibrillation in hemodynamically stable patients be treated?
Beta blockers
49
What are ST elevations in V1-V3 associated with?
Syncope, arrhythmia, or sudden cardiac death ## Footnote Anesthetic medications like propofol and local anesthetics may predispose affected patients to fatal arrhythmias. More common in men of Asian descent.
50
What is the treatment for new onset atrial fibrillation in hemodynamically stable patients?
Beta blockers or calcium channel blocker (diltiazem) ## Footnote Amiodarone is not considered a first line agent in management of atrial fibrillation.
51
What is the most accurate method to assess blood pressure in a patient with a left ventricular assist device (LVAD)?
Arterial line to monitor MAPs ## Footnote Noninvasive monitoring such as BP cuffs and pulse oximeters may not function properly due to lack of adequate pulsatility.
52
What are the absolute contraindications for minimally invasive coronary artery bypass?
Subclavian artery occlusion, cardiogenic shock due to acute LAD occlusion ## Footnote Surgical method involves left anterior descending artery (LAD) revascularization via anastomosis to left internal mammary artery via a left sided thoracotomy.
53
How does a cardiopulmonary bypass machine work?
Diverts venous blood away from right atrium into a venous reservoir, through an arterial pump, heat exchanger, oxygenator, and arterial filter, returning it to the patient's arterial system via an arterial cannula.
54
Which pump is less traumatic in cardiopulmonary bypass?
Centrifugal pumps ## Footnote Less traumatic than roller pumps.
55
How does venous oxygen saturation change with methemoglobinemia?
Increases ## Footnote Methemoglobinemia results in increased affinity for oxygen, decreasing oxygen unloading at the tissue level.
56
What is epinephrine's desired effect in cardiac arrest?
Alpha 1 adrenergic receptor agonism, which increases arterial blood pressure during CPR.
57
What is the preferred initial vasoactive agent in cardiogenic shock?
Dobutamine ## Footnote Dobutamine improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.
58
What are the cardiovascular changes in the elderly?
Arterial stiffening, aortic valvular calcification and stenosis, compensatory left ventricular hypertrophy, decreased beta adrenergic sensitivity ## Footnote Includes preserved systolic function and increased sympathetic activity.
59
What drugs should be used on denervated hearts (heart transplants)?
Direct adrenergic agonists such as dobutamine, isoproterenol, epinephrine, norepinephrine.
60
What are the characteristics of abnormal intraaortic balloon pump tracings?
Balloon should inflate during diastole and deflate during systole.
61
What is the inverse-steal or Robin Hood phenomenon?
Interventions causing cerebral vasoconstriction preferentially vasoconstrict normal portions of the brain, improving blood flow to areas with impaired flow.
62
What occurs during the intracerebral steal phenomenon?
Normal cerebral vasculature dilates in the setting of a focal obstructive lesion, reducing flow past the obstruction.
63
What is the primary process that compensates for heart failure?
Sodium retention due to decreased renal perfusion activating RAAS. ## Footnote Compensatory mechanisms include increased sympathetic activity and fluid retention.
64
What is endovascular abdominal aortic repair recommended for?
Descending thoracic aortic aneurysms distal to the subclavian. ## Footnote More likely to require minor reinterventions compared to open surgical repair.
65
What are the contraindications for intra-aortic balloon pumps?
Moderate to severe aortic valvular insufficiency, aortic disease, severe peripheral vascular disease, severe aortic atherosclerotic plaque formation.
66
What should be noted regarding synchronized cardioversion for an arrhythmia?
There may be significant delay between the button pressed and shock delivered.
67
What is the most common differential diagnosis for acute postoperative hypertension?
Pain, anxiety, hypoxemia, hypercarbia, inadequate preoperative hypertension optimization.
68
What are intraoperative causes of hypertension?
Inadequate pain control, fluid overload, vasopressors, bladder distension. ## Footnote Direct laryngoscopy and tracheal intubation can produce significant hypertension.

Anesthesiology Advanced TL (5 decks)

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