CV 1

Question 1

6 Therapies for CHF

Answer 1

1- ID treatable etiologies
2- Treat decreases contractility : Digoxin( carditonic ) , Beta agonists-Dopamine, Amrinone ( PDE inhibitor to decrease pressures )
3- Treat high Prelaod
4- Treat High afterload: ARB, ACE
5- Digoxin : increases Ca++ by inhibiting Na/K ATPase pump , Beware of Dig tox w/ hypokalemia ( elderly, renal insufficiency, diuretic )
EKG flicking of dig toxicity : PVCs , ST depression aka DIG EFFECT , Paroxysmal Atrial tachycardia with varying block
6- Diuretics

Question 2

Dig Toxicity

Answer 2

Hypokalemia BC digoxin more affinity for myocardium when K is low ex: elderly, renal insufficiency, diuretics

EKG :
PVCs,
St depression ( Dig Effect )
Paroxysmal Atrial Tachycardia w/ varying blocks

Question 3

7 anesthesia concerns in CHF

Answer 3

1. Slightly head elevated
2. Watch Fluid Status very carefully
3. Risk of overdose due to slow circulation
4. Watch I and O s
5. Sensitive to anesthetic gases
6. Nitrous Oxide in severe CHF is avoided
7. Watch arrhythmia bc it is poorly tolerated

Question 4

ABCDE treatment of heart Failure

Answer 4

ACE inhibitor
Beta Blockers
CCB
Diuretics
Endothelin Receptor blockers ( Bosentan/Tracleer )  =>> decrease pulmonary vascular resistance

Question 5

MAP calculation

Answer 5

SBP + 2DBP/3

CO x SVR

Question 6

CO calculation

Answer 6

HR X SV

Question 7

3 factors determine stroke volume

Answer 7

Afterload, Preload and contractility

Question 8

2 factors determine Prelaod

Answer 8

Venous Tone

Intravascular volume

Question 9

What effect of venous constriction on preload

Answer 9

Increase Preload , the opposite is true

Question 10

What is the major determinant of Intravascular Volume ?

Answer 10

Na+

Question 11

Most important hormone for controlling vascular volume

Answer 11

Aldosterone

Question 12

What Is Ejection fraction ?

Answer 12

Fraction of the end diastolic volume ejected in each stroke volume
normal EF 60 - 80%
Is an index of systolic contractility

Question 13

What is the Ejection Fraction formula?

Answer 13

Stroke Volume ÷ End Diastolic Volume

Question 14

Formula for SVR

Answer 14

MAP - CVP 
—————  X 80 
        CO 
Normal 
1200 to 1500 Dynes.sec.cm5

Question 15

Major determinant of SVR

Answer 15

Arterioles are major determinant of SVR

Question 16

Body Sodium determines

Answer 16

Extracellular and Intracellular volume

Question 17

Preload determined by

Answer 17

Venous tone and Intravascular volume

Question 18

Stroke Volume determined by

Answer 18

Preload, Afterload, Contractility

Question 19

CO is determined by

Answer 19

SV and HR

Question 20

MAP is determined by

Answer 20

CO and Systemic vascular Resistance

Question 21

SVR determined by

Answer 21

Afterload ( arteriole resistance)

Question 22

Coronary Circulation , how much of the CO ?

Answer 22

5% of the CO

250ml/min @ rest

Question 23

What is the formula for Coronary perfusion Pressure ?

Answer 23

Arterial Diastolic Pressure - LVEDP

Question 24

Increased EDP does what to coronary arteries ?

Answer 24

Constrict coronaries

Question 25

Effect fo Diastolic dysfunction on coronaries

Answer 25

Interrupt blood supply to coronaries