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CV II Flashcards

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1
Q

Every anesthetic has what kind of effect on the cardiovascular system?

A

Every anesthetic has either a direct or indirect effect on the cardiovascular system

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2
Q

The failing heart becomes increasingly dependent on circulating what?

A

The failing heart becomes increasingly dependent on circulating catecholamines**

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3
Q

Decreases in circulating catecholamine levels, such as can occur following induction of anesthesia (such as proprofol and fenatnyl) , may lead to what?

A

Decreases in circulating catecholamine levels, such as can occur following induction of anesthesia (such as proprofol and fenatnyl) , may lead to acute cardiac decompensation**

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4
Q

Arteriosclerosis is a chronic disease of the arterial system which is characterized by what?

A

Arteriosclerosis:
Chronic disease of the arterial system, characterized by:
-Abnormal thickening and hardening of vessel walls
-Decrease in the artery’s ability to change lumen size, lumen is gradually narrowed (changes in lipid, cholestoral, and phospholipid withing in tunica intima, which will contribute to arteriosclerosis

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5
Q

what are the pathophysiologic conditions of arteriosclerosis?

A

Pathophysiologic conditions;

  • High blood pressure*
  • Insufficient perfusion of tissues*
  • Weakening of arterial walls*
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6
Q

What is the leading contributor to coronary artery and cerebrovascular disease?

A

Atherosclerosis

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7
Q

How does atherosclerosis form?

A

Form of arteriosclerosis, thickening and hardening of the vessel walls are caused by soft deposits of intra-arterial fat and fibrin that harden over time

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8
Q

Approximately what fraction of people over the age of 65 have HTN?

A

Approximately two thirds of people over the age of 65 years have hypertension**

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9
Q

what is the primary risk factor for development of CAD?

A

HTN

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10
Q

How much of the population does HTN affect?

A

Affects ~ 60 million people

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11
Q

What is primary HTN?

A

Essential (primary) HTN

  • No identifiable cause
  • Accounts for 95% of all cases
  • Diagnosis determined on the basis of exclusion
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12
Q

What is Secondary HTN?

A

Remedial (secondary) HTN

  • Has an identifiable and curable cause
  • Causes of secondary HTN include;
  • –Pheochromocytoma, coarctation of the aorta, renal artery stenosis, primary renal diseases, Conn’s disease (primary aldostaronism?), and Cushing’s disease (hyper cortisol)
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13
Q

What is the pathophysiology of HTN?

A

Pathophysiology:

  • Some degree of sympathetic dysfunction is responsible for essential HTN
  • Dysfunction of the sympathetic nervous system leads to chronic vasoconstriction (intravascular volume status will decrease)
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14
Q

What is the goal of antihypertensive therapy??

A

To maintain normal tension on a consistent basis

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15
Q

True or false?

Anesthesia care providers must have an adequate understanding of agents used to treat HTN

A

True.

Anesthesia care providers must have an adequate understanding of agents used to treat HTN

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16
Q

What should you do with medications for HTN until the time of surgery?

A

Anesthesia management:
Medications for HTN should be continued on schedule until the time of surgery***

Mild preoperative sedation may be indicated

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17
Q

what may happen with anesthesia induction agents and with patients with hypertension?

A

Anesthesia induction agents may induce hypotension (patients maybe hypovolumic)

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18
Q

Patients with HTN react in a exaggerated response to what two things??

A

Patients with HTN react in an exaggerated response to induction agents and stimulation**

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19
Q

Patients with HTN, what is the goal for the maintenance of anesthesia?

A

maintenance of anesthesia:

  • Goal is to maintain BP stability within 20% of the normal mean pressure
  • Intra-op events causing wide fluctuations in BP should be anticipated and treated
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20
Q

With patients that have HTN, what is the most common event precipitating intra-op HTN??

A

Surgical stimulus is the most common event precipitating intra-op HTN (may wanna give narcotic before stimulus)

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21
Q

Patients with HTN, What intra-op condition should be immediately recognized, diagnosed, and treated??

A

Profound hypotension during surgery should be immediately recognized, diagnosed, and treated

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22
Q

Patients with HTN, Intra-op cardiac morbidity is associated with what?

A

Intra-op cardiac morbidity is associated with prolonged severe hypotension

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23
Q

What are the postoperative considerations for patients with HTN?

A
  • Early in the postoperative period initiation of adjunct administration of antihypertensive medications should be considered
  • Primary antihypertensive consideration is the adequate control of pain
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24
Q

How much fluid should be in the pericardium?

A
  • Pericardial space usually contains 20-25 ml of clear fluid
  • Under normal circumstances can accommodate gradual fluid fluctuations
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25
What is the pericardium consist of?
Consists of an inner visceral (think organ) layer and an outside parietal layer
26
Rapid accumulation of pericardial fluid in the pericardial space can result in what two events?
Rapid accumulation of pericardial fluid in the pericardial space can result in cardiac tamponade and cardiovascular collapse
27
ACUTE PERICARDITIS - Acute inflammation of the pericardium is caused by a number of disorders that include?
ACUTE PERICARDITIS Acute inflammation of the pericardium is caused by a number of disorders (can be caused by post MI syndrome, metastatic disease, TB, rheumatoid arthritis, viral infection)
28
What are the clinical presentation of acute pericarditis?
- Chest pain with sudden onset is the associated principle symptom - Inclusion of a pleural component
29
Chronic constrictive pericarditis results from what?
Results from pericardial thickening and fibrosis (back in the day tb was the cause, most common cause is idopathic)
30
What is the anesthetic management of chronic constrictive pericarditis?
Anesthetic agents should preserve myocardial contractility* (will be fixed), heart rate* (don’t want this to go down), preload* (will be fixed), and afterload
31
What is cardiac tamponade?
Intrapericardial pressure is influenced by the accumulation of fluid
32
What is the pathophysiology of cardiac tamponade?
Pathophysiology: - Accumulation of pericardial fluid causes an increase in intrapericardial pressure - Poor ventricular filling develops - Decrease in SV stimulates compensatory mechanisms for maintaining CO - Cardiac collapse can occur if compensatory mechanisms fail (first HR will increase, vasoconstriction)
33
What is the pathophysiology of heart failure?
Systolic heart failure occurs when the heart is unable to pump a sufficient amount of blood to meet the body’s metabolic requirements
34
What is reduced in most forms of heart failure?
CO is reduced in most forms of heart failure****
35
What is the compensatory mechanisms for the pathophysiology of heart failure?
Compensatory mechanisms: - Increased preload - Increased sympathetic tone (2nd to NE and Epi) - Activation of the renin-angiotensin-aldosterone system (eventually this is a good compensatory system but at a certain point it will fail) - Release of AVP (argenin vasopressin increase ventrular afterload in the attempt to increase SV) )(primary goal is to increase O2 to the tissue, this is done by increase SV) - Ventricular hypertrophy
36
Initially compensatory mechanisms are effective in the pathophysiology of heart failure, but eventually what may happen?
Initially compensatory mechanisms are effective, with increasing severity of cardiac dysfunction compensatory mechanisms may contribute to cardiac impairment
37
With cardiac risk factors, CV complications account for how much of deaths following noncardiac surgery?
CV complications account for 25-50% of deaths following noncardiac surgery
38
Intra-op MI, pulmonary edema, CHF, arrhythmias, and thromboembolism are most commonly seen in patients what patient population?
Intra-op MI, pulmonary edema, CHF, arrhythmias, and thromboembolism are most commonly seen in patients with preexisting CV disease
39
What are the two most important preoperative cardiac risk factors?
Two most important preoperative risk factors: - History of recent MI* (less than one month) - Evidence of CHF*
40
With cardiac risk factors, what are the three generally accepted contraindications to elective noncardiac surgery?
Generally accepted contraindications to elective noncardiac surgery include: - MI less than 1 month prior to surgery - Uncompensated heart failure - Severe aortic or mitral stenosis
41
What are the preoperative considerations of ischemic heart disease?
ISCHEMIC HEART DISEASE Preoperative considerations: Myocardial ischemia is characterized by a metabolic oxygen demand that exceeds oxygen supply
42
What are the risk factors that are associated with CAD?
k factors associated with CAD (include htn Dm smokin, increase in age, male gender, positive family history, hyperlipidemia)
43
What usually reflects underlying coronary disease and frequently precedes MI?
Unstable angina
44
What patient population has a relatively high incidence of silent ischemia (ones with chronic stable angina)?
Diabetics have a relatively high incidence of silent ischemia
45
With what condition does blood flow generally is adequate at rest but becomes inadequate with increased metabolic demand?
Chronic stable angina
46
What is the treatment of ischemic heart disease?
Correction of complicating medical conditions that can exacerbate ischemia
47
For the treatment of ischemic heart disease, what would pharmacologic manipulation consist of?
Pharmacologic manipulation of the myocardial oxygen supply-demand relationship
48
What are the three most common pharmacologic agents used to treat ischemic heart disease?
Most commonly used pharmacologic agents: -Nitrates (relax vascular smooth muscle, reduce wall tension and after load) -Calcium channel blockers (reduce myocardial o2 demand by decrease after load, will decrease) coronary blood flow) -β-adrenergic blocking agents reduce hr and contractility and reduce after load Other agents (antidysritimcs, ace inhibitors)
49
Patients with ischemic heart disease and regional anesthesia should be used for what procedure?
Regional anesthesia for extermitites, perineum, and lower abdomen, avoid marked hypotension, avoid excessive sedation
50
General anesthesia with ischemic heart disease should be aim at what?
Maintenance agents; good ventricular function managed with volatile anesthetic-based technique, depressed ventricular function managed with opioid based anesthetic
51
What are the postoperative management for patients with ischemic heart disease?
Possible 12-lead ECG to detect unrecognized ischemia Provide supplemental oxygen until adequate oxygenation is established
52
What is the normal valve orifice for mitral stenosis?
Symptoms generally develop after 20-30 years, normal valve orifice is reduced from 4-6 cm2 to less than 2 cm2***
53
With mitral stenosis, blood flow depends on what three factors?
Blood flow depends on HR, CO, and atrial kick
54
What is the anesthetic management for mitral stenosis?
Principle goals are to maintain sinus rhythm, avoid tachycardia, large increases in CO, hypovolemia, and fluid overload**
55
Patients with mitral regurgitation, what is the principle derangement?
Principle derangement is a reduction in forward stroke volume*** systole will have backward blood flow
56
What happens in patients with Mitral regurgitation in terms of the LV?
LV compensates by dilating and increasing EDV in the attempt to increase forward volume
57
For the anesthetic management of mitral regurgitation, what should be avoided?
Slow heart rates and acute increases in afterload should be avoided
58
For the anesthetic management of mitral valve prolapse, what should be avoided?
hypovolemia and factors that increase ventricular emptying should be avoided
59
For the anesthetic management of patients with mitral valve prolapse, what should you do with asymptomatic patients and ATB?
Asymptomatic patients; ATB prophylaxis
60
For patients with aortic stenosis, obstruction is usually gradual to where?
Obstruction is usually gradual to left ventricular outflow
61
With aortic stenosis, CO may be what at rest?
CO may be normal at rest but does not appropriately increase with exertion
62
With aortic stenosis, what drugs do we use and what do we monitor for?
Treatment diuertics, digoxin Monitoring: for ischemia
63
Aortic regurgitation can be classified as what?
Maybe chronic or acute
64
Aortic regurgitation may do what to volume?
Produces volume overload of the LV
65
With aortic regurgitation, what happens to stroke volume?
Effective forward stroke volume is reduced
66
With aortic regurgitation, what happens to diastolic pressure and SVR?
Systemic arterial diastolic pressure and SVR are low
67
With aortic regurgitation, what is the volume dependent on?
regurgitant volume dependent on HR and diastolic pressure gradient across the aortic valve
68
What happens to the autonomic influences in patients with a transplanted heart?
Transplanted heart is denervated so direct autonomic influences are absent
69
What happens to cardiac impulse formation and conduction in patients with a transplanted heart?
Cardiac impulse formation and conduction are normal
70
What happens to circulating catecholamines in patients with a transplanted heart?
The response to circulating catecholamines is normal or even enhanced
71
What happens to the CO in patients with a transplanted heart?
CO tends to be low-normal and increases relatively slow in response to exercise
72
What should the preoperative evaluation focus on with a patient that will be getting a transplanted heart?
Preoperative evaluation should focus on evaluating the functional status of the transplanted heart and detecting complications associated with immunosuppression
73
What is the anesthetic management for a patient with a transplanted heart?
- Nearly all anesthetic techniques have been used successfully - Maintenance of a normal or high cardiac preload desirable - Indirect vasopressors are less effective ephedrine - Isuprel and epinephrine should be available to increase HR - HR related responses to various medications administered intraoperatively are absent

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