Cardioplegia Bruce's Final Exam Flashcards Preview

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Flashcards in Cardioplegia Bruce's Final Exam Deck (32)
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1

Chemical Cardioplegia effect on the heart?

Changes the resting membrane potential of the myocardium rendering it unexcitable

2

Intracellular
Na+ =
K+ =
Cl- =

Na+ = 12mM
K+ = 139mM
Cl- = 10 nM

3

Extracellular
Na+ =
K+ =
Cl- =

Na+ = 145 mM
K+ = 4 mM
Cl- = 150 nM

4

Cardiac muscle
(Atrial & ventricular)
resting potential mV?

- 80

5

Cardiac purkinje fiber
resting potential mV?

- 90

6

Atrioventrcular nodal cell resting potential mV?

-65

7

Sinoatrial Nodal cell resting potential mV?

- 55

8

Cardiac threshold2 is =

about 70

9

5 Constituents of Cardioplegia ?

• Hypertonic
• Buffered
• Oxygen Delivery
• Calcium
• Arresting agent

10

– [K+] > 40 =

cell membrane damage

11

Advantages of Chemical cardioplegia ?

Recovery of Function

12

Disadvantages of Cardioplegia

• Ischemic Injury
• Calcium Paradox
• Stone Heart

13

Cellular response to ischemia

Protein production
• Humeral signaling agents
• Cell membrane receptors
• Self destruct messages
• Immune Reaction and Apoptosis (programmed cell death)

14

Prevent Calcium Paradox with what ?

diltiazem or
trace calcium levels

15

What is Calcium paradox?

in vivo model of multidose cardioplegia and moderate hypothermia

16

Low levels of ATP and a calcium overload can lead what?

(Stone Heart)

17

(Stone Heart)

“massive contraction band necrosis in an irreversibly noncompliant hypertrophied heart

18

Lethal Ischemic injury occurs during ?

Re-perfusion

19

Oxygen Supply < Oxygen demand. What is the cellular response?

Programmed cell death

20

Run out of ATP (energy) > leads to what ?

-Calcium leaks out of the SR
-Calcium leaks out of the cell
-Reperfusion with Ca leads
to massive Ca release
- Absence of ATP results in
tetanic contracture (rigor
mortis)

21

(Q10) For every 10 degree change in temperature causes what?

metabolic rate is cut by 1/2.

22

card 23

card 23

23

Intermittent cardioplegia

has long controlled periods of ischemia

24

Continuous cardioplegia strives for what?

No Ischemia

25

Warm + Ischemia =

BAD

26

Cardioplegia temperature delivered to the heart at _____ reduces MVO2 to what _____ ?

22 degrees

97%

27

O2 delivery of blood is ?

Lowered with
low termperatures

28

Warm fibrillating heart =

Increased MVO2

29

hand held cannulas directly into individual coronary arteries is a technique necessary any time the?

Ao Root is opened
(Ao valve surgery, Ao repairs)

30

For pre-operative ischemia what protocol should be used?

- Warm induction
- Initiation: Reperfusate bag + 12.5 ml K+
Q = 150 ml 3min A/R
- Follow with 100 ml cold multidose