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Anesthesia & Coexisting Disease > Ex1 L2 > Flashcards

Ex1 L2 Flashcards

1
Q

Ion most responsible for resting membrane potential

A

Potassium

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2
Q

What does not occur in SA node?

A

Rapid depolarization

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3
Q

Largest perfusion to coronaries

A

During diastole

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4
Q

Increased demand of O2 from

A

Increased:

HR, afterload, contractility

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5
Q

Simple form - angina pectoris

A

Mismatch of O2 supply & demand

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6
Q

Hearts way of compensating a mismatch in supply/demand of O2

A

Decreased HR + contractility

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7
Q

Angina pectoris risk factors

A 
Males
Increasing age
HTN
HL
Smoker
DM
Obesity
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8
Q

Stable angina

A

Chest pain not changing for 2+ months

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9
Q

Unstable angina

A

Pain at rest, new onset, or increase in severity/frequency

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10
Q

Angina - diagnosis

A

ECG

Non-invasive or invasive imaging

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11
Q

Best information of coronary arteries

A

Coronary angiography

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12
Q

Revascularization

A

CABG or PCI +/- stents for failed medical management
LMCA occlusion > 50%
Significant CAD + EF 40%

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13
Q

Tx STEMI

A 
MONA
Beta Blockers
Reperfusion therapy
PCI 
CABG
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14
Q

Beta blockers should be avoided in

A

HF
Low CO or cardiogenic shock
Heart block

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15
Q

Reperfusion therapy should occur

A

30-60 minutes from arrival

**w/in 12h of onset

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16
Q

PCI should occur within

A

90 minutes of arrival

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17
Q

After angioplasty (w/o stenting) - time to wait for elective surgery

A

2-4 weeks

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18
Q

After bare metal stent placement - time to wait for elective surgery

A

At least 30 days

12 weeks preferable

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19
Q

Reperfusion therapy

A

TPA alteplase etc.

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20
Q

Reperfusion therapy risk

A

History of bleeding or hemorrhagic stroke — careful

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21
Q

After CABG- time to wait for elective surgery

A

At least 6w

Prefer - 12 w

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22
Q

After DES placement - time to wait for elective surgery

A

At least 12 months

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23
Q

Periop monitoring - stent pts

A

Must have interventional cardiologist on staff/available

*STAT consult for angina

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24
Q

Anesthesia techniques for stent pt

A

Neuraxial techniques not prudent unless anticoagulants held for 5-10 days prior

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25
DES < 12 months + dual antiplatelet therapy
**Consult cardiology Emergency surgery is 3.5x risk adverse events Major risk of adverse cardiac events if d/c antiplatelet therapy + non cardiac surgery
26
UA/NSTEMI diagnosis
3 principal presentations: 1. Angina at rest ( > 20 min) 2. chronic angina pectoris that is more easily provoked 3. New-onset angina (severe) * often presents with arrhythmias
27
UA/NSTEMI ECG
Significant ST-segment depression in 2+ leads +/or Deep symmetric t-wave inversion
28
UA/NSTEMI Tx
Decrease O2 demand Bed rest, O2, analgesia, BB, CaBlockers, ASA/clopidogrel, heparin NO THROMBOLYTIC THERAPY
29
Cardiac risk factors in pts undergoing elective major non cardiac surgery
- high risk surgery - IHD - CHF - CVA - IDDM - Cr > 2 mg/dL * more risk factors = greater risk of complications
30
Hold ACE inhibitors when?
24h prior to surgery
31
Intraop events that decrease O2 delivery
``` Tachycardia Decreased DBP Hypocapnia Anemia Arterial hypoxemia Shift of oxyhem —> L Coronary artery spasm ```
32
Intraop events that increase O2 requirements
Increased: | HR, BP, SNS, contractility, pre/afterload
33
Intraop MI - Tx
Nitroglycerine If needed: sympathomimetics (restore coronary pressure) + fluids (restore bp)
34
Preferred volatile with intraop MI
Sevoflurane
35
Evaluation of cardiac reserve
Exercise tolerance
36
Cardiomegaly
Heart > 50% thoracic cage in chest radiograph
37
Valve replacement that requires long-term anticoagulation
Mechanical (prosthetic)
38
Pt cannot tolerate anticoagulation - which type of valve replacement do they most likely have?
Bioprosthetic
39
Pt on Coumadin - major surgery planned. When to hold?
3-5 days preoperatively | IV/SubQ heparin or LMWH until day prior or day of surgery
40
When is antbx prophylaxis recommended?
1. Dental procedures (+ gingival/periapical/perf of oral mucosa) 2. invasive procedures (incision/biopsy of resp/infected skin/skin structures/musculoskeletal) **NOT GI/GU *Exceptions: Congenital heart dx, cardiac transplant (cardiac valvulopathy), immunocompromised
41
Commonly associated with mitral stenosis
Afib, pulmonary edema | over time—> pHTN, RHF
42
Pts with mitral stenosis should be taking
Anticoagulation | Prevent embolic stroke: 7-15%
43
Mitral stenosis: diagnosis
Echo | Valve area < 1.5 cm^2
44
Opening snap - diastole (murmur)
Mitral stenosis
45
Pulmonary edema - common in mitral valve stenosis when?
Afib, sepsis, pregnancy
46
Mitral Stenosis - risks associated
High risk for systemic thromboembolism - should be on anticoagulation especially if Afib
47
Mitral Stenosis - ECG
p wave notch (LA hypertrophy) | Not always
48
Mitral Stenosis Tx
1. Diuretics 2. HR control (increased HR=increased LA pressure/decreased LV filling) 3. Anticoagulation 4. Surgery: symptomatic +/- pHTN
49
Anesthetic Rx - Mitral Stenosis
Preop: anxiolytics to reduce tachy Induction: balanced or nitrous/narcotics *avoid ketamine, atracurium Resume anticoagulation asap
50
Wedge pressure in mitral regurgitation
Overestimate LV filling pressure | LAP > LVEDP
51
Size of___ wave in PAOP correlates with _____
V wave | Magnitude of mitral regurgitation
52
Mitral regurgitation - anesthetic goals
Afterload reduction *CO - maintained (via increased HR, decreased SVR) I.e. nitroprusside gtt to decrease SVR
53
Induction Rx - Mitral regurgitation
Etomidate/Ketamine are okay — do not want to decrease HR
54
Factors associated with aortic stenosis
1. Degeneration/calcification of leaflets—> stenosis | 2. Presence of bicuspid rather than tricuspid valve
55
Most common valvular dx
Aortic stenosis
56
Normal aortic valve area
2.5-3.5 cm^2
57
Critical AS
Valve < 0.8 cm^2 + Transvalvular pressure gradient > 50mm
58
Aortic Regurgitation - maintenance mneumonic
Full, Fast, Forward
59
A-Line changes with aortic regurgitation
Bisferins pulse
60
ECG changes with aortic regurg
Widened QRS
61
Goal hr/bp aortic regurg
Do not increase SVR (forward) | HR > 80, do not decrease (fast)
62
Drug to avoid in aortic regurg
Phenylephrine (decrease HR)
63
ECG changes - tricuspid regurg
Peaked p wave (leads II, III, aVF)
64
Drugs to avoid in tricuspid regurg
Nitrous
65
Causes of pulmonic valve regurg
pHTN

Anesthesia & Coexisting Disease (23 decks)

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