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RUSVM Anesthesiology > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

1
Q

How are you going to monitor cardiac patients ?

A

ECG, indirect BP, ETCO2, temp

Invasive arterial BP in certain patients

Cardiac output monitoring may be available in certain situations

External pacing device with ECG for 3rd degree AV block

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2
Q

What is the difference between hypovolemic and septic shock?

A

Hypovolemic —> decreased preload

Septic -> decreased preload due vasodilation, and decreased contractility due to inflammatory mediators

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3
Q

What are the indications for treating ventricular premature complexes?

A

Rate > 180

R on T phenomenon

Multiform

Causing hypotension

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4
Q

You have a patient in shock, what pre-operative treatments will you do?

A

Adequate fluid resuscitation with appropriate fluids
-> hemoabdomen may require blood products before/during procedure

Correct severe hypoglycemia or hypocalcemia (common in septic patients)

Analgesics

HR should be 120-140 and BP should be >90 prior to induction

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5
Q

What drugs are you going to avoid in shock patients?

A

Phenothiazines > vasodilation and decrease BP

A2 agonsit > vasoconstriction and bradycardia

Propofol > vasodilation, decreased contractility

Pre-op atropine > tachycardia (can use intra op for bradycardia)

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6
Q

What drugs can be used in shock patients??

A

Opioids and benzo -> reversible with minimal CV effects

Etomidate and alfaxalone -> minimal CV effects

Ketamine -> mild CV stimulation

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7
Q

How do you manage intra-operative hypotension in shock patient ?

A

Keep inhalant anesthetic as low as possible

Multi-modal therap - opioid, lidocaine, ketamine, benzo

Fluids

  • crystalloid +/- colloid
  • hypertonic NaCl

Vasopressor and inotropes

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8
Q

What is drug therapy for vasodilation ?

A

Dopamine
Norepi
Ephedrine
Vasopressin

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9
Q

What are your drug therapies for poor inotropy ?

A

Dobutamine

Dopamine

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10
Q

What dogs commonly have mitral valve disease?

A

Older small breed dog

CKCS

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11
Q

Your giving your mitral valve disease patient diuretics, ACE inhibits, and pimobdenan to control CHF. Which one of these should be withheld the morning of surgery and why?

A

ACE inhibitors

Avoid refractory hypotension

This goes for any patient that has CHF (eg same in DCM dog)

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12
Q

What type of fluids may be more appropriate for increasing vascular volume in a patient with mitral valve disease?

A

Colloids

Patients do not tolerate excess IV fluids —> CHF (pulmonary edema)
Crystalloids can redistribute causing more edema

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13
Q

What drugs do you AVOID in patients with mitral valve disease?

A

Phenothiazines > vasodilation

A2 agonsit > increase afterload

Propofol >vasodilation

Pre op atropine > tachycardia

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14
Q

What drugs do you use in mitral valve disease

A

Opioid and benzo

Etomidate/ alfaxalone

Ketamine (except with pre-existing tachycardia)

Dobutamine or dopamine for hypotension

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15
Q

Dilated cardiomyopathy results in _________ dysfunction

A

Systolic

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16
Q

The enlarged right atrium in DCM predisposes animals to what type arrhythmia?

A

Atrial fibrillation

17
Q

What drugs can be used in DCM?

A

Opioid and benzo

Alfaxalone and etomidate

Dobutamine and dopamine for hypotension

18
Q

When do you want to avoid ketamine in DCM?

A

If atrial fibrillation or sinus tachycardia is present

19
Q

What breed of cats commonly get hypertrophic cardiomyopathy?

A

Maine coon

20
Q

HCM can lead to CHF, how should this be treated prior to anesthesia?

A

Diuretics, ACE inhibitors

Thoracocentesis - under sedation like butorphanol and benzo

21
Q

What drugs can we use in our HCM cats?

A

Opioid and benzo

Alfaxalone and etomidate

Dopamine preferred for hypotension

22
Q

What is a shunt form L -> R, aorta to pulmonary artery?

A

Patent ductus arteriosus (PDA)

23
Q

PDA causes a volume overload to the _______ side of the heart resulting in what type of remodeling?

A

Left

Eccentric hypertrophy

24
Q

What are the options for PDA treatment??

A

Surgical: thoracotomy with PDA ligation

Coil occlusion

25
Q

At the time of PDA occlusion, diastolic BP will increase dramatically. How does this affect HR and how do you treat this?

A

Result if reflex bradycardia

Treat with atropine

26
Q

What drugs can you use during PDA surgery?

A

Opioid and benzo

Alfaxalone, etomidate, profofol and ketamine

Pre-anesthetic anticholinergic

Locoregional anesthetic for thoracotomy (intercostal blocka Nd intrathoracic local anesthesia +/- morphine epidural)

27
Q

Pulmonic stenosis causes increased pressure of the _________ ventricle, resulting in what type of cardiac remodeling?

A

Right

Hypertrophy

28
Q

How is pulmonic stenosis treated?

A

Balloon valvuloplasty

29
Q

What are you going to be cautious about during pulmonic stenosis surgery?

A

Avoid excessive fluid administration
Maintain HR
Ready to treat ventricular arrhythmia

30
Q

What clinical signs can result due to 3rd degree AV block?

A

Syncope and exercise intolerance

HR is usually 30-40bpm

31
Q

T/F: patients with 3rd degree AV block should not be anesthetized unless for pacemaker placement or life-threatening emergency

A

True

32
Q

How is HR maintained in patients with 3rd degree AV block during anesthesia?

A

Pacemaker

  • transcutaneous
  • temporary transvenous

The permanent pacemaker can be placed trans-diaphragmatic through the jugular vein with fluoroscopic guidance

33
Q

What drugs should you absolutely avoid in 3rd degree AV block?

A

any that cause vagal simulation, bradycardia, or hypotension

  • a2 agonsit
  • acepromazine
  • pure mu (can cause vagal stim)
34
Q

What drugs CAN be used during pacemaker placement for 3rd degree Av block?

A

Anticholinergic

Butorphanol and benzo

Ketamine (might help increase HR)
Etomidate or alfaxalone

Local anesthetics

35
Q

T/F: an accelerated idioventricular rhythm will respond to lidocaine

A

Nope

36
Q

What are the 3 arrest rhythms ?

A

Ventricular fibrillation
Asystole
Pulseless electrical activity

RUSVM Anesthesiology (32 decks)

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