Final Flashcards by Kira Harms

virchow triad

venous tasis
hypercoag
vascular endo disruption

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thoracic aneurysm cause

genetic

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abdominal anesurysms cause

lifestyle

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peripheral vascualar disease casuse

smoking
lifestyl

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coronary subclavian steal

sends blood from the heart to arm

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subclavian steal

sends blood from brain to arm

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BP in affected arm of subclavian steal is

lower

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raynaud’s treatment

keep warm
avoid art line
avoid epi additive

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3 protection mechanisms for neuro

SSEP/EEG
ice epidural
CSF drain

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AAA ruptures into

L retroperitoneum

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AAA rupture triad

pulsatile abdominal mass
severe back pain
hypotension

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temporal arteritis risk

high fire risk

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brain blood supply is ______ of CO

20% of CO

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brain blood supplied by

internal carotids
vertebral arteries

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vertebral arteries combine into the

basillar arteries

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what combines in the circle of willis

basilar and internal carotids

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innermost layer of artery

endothelium

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atherosclerosis

response to vessel wall injury
results in endothelium dysfuntion

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indication of vascular disease

claudication

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aneurysm

abnormal weakening of vessel

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dissection

tear in intima
false lumen

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primary cause of thoracic aortic disease

genetic bicuspid aortic valve

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stanford A

ascending

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stanford B

no ascending

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goal vascular ACT

200-300s

heparin dose for vascular

100U/kg

spinal cord ischemis risk increases with

corss clamp > 30s

radial art line for thoracic repair

right

BP above/below clamp

above: 100 mmHg below: 50 mmHg

clevidipine dosing

2mg/hr max: 32 mg/hr

highest risk of endovascular AAA repair

stent migration/thrombosis

when can you extubate carotid endarctectmy

when awake enough to follow commands

CAE damage

laryngeal nerve injury carotid body injury

most important DVT complication

best DVT prevention

lovenox

recurrent PE treatment

IVC filter

DVT prevention in pts who are CI to anticoags

IVC filter

CoW

protects agains ischemia/stroke collateral circulation

in order for collateral flow through CoW

pressure must be high enough for retrograde flow - contralateral anterior - middle cerebral

SV factors

preload afterload contractility

contractility is independend of

preload afterload

estimate preload

LV EDP ~ PAWP

estimate SVR

SVR ~ MAP or SBP

incr SVR ____ CO

incr SVR = decr CO

all heart disease has

incr VEDP

LVEDP ~

LVEDP ~ PAWP

LVEDV ~

LVEDV ~ CO = HRxSV

normal CI

2.5-4.2

systolic HF

HFrEF LV systolic dysfunction

diastolic HF

HFpEF poor relaxation = poor filling

systolic HF tachycardia

incr CO

diastolic HF tachycardia

decr CO

HF general compensation

decr Vmax incr SVR incr sympa incr vascular tone

Frank starline

incr filling pressure needed to mx SV/CO

what compensates for increased pressure

hypertrophy

hypertrophy state

low inotropic state

what compensates for fluid overload

dilation

most common myocardial remodeling

ischemic injury

treat myocardial remodeling

ACE aldosterone inhibitors

what is associated w/HF

elevated BNP

balloon pump diastole

inflates

balloon pump systole

deflates

causes of RHF

LV failure PHTN RH MI

most common cause of RHF

LV failure

causes of LHF

LH MI chronic HTN acute HTN aortic/mitral dz

high output HF

good CO poor perfusion

high output CO diagnosis

CO > 8L/min CI> 4 L/min/m2

normal SVR

700-1200

normal PA

< 20 mmHg

low contractility (LOW CI), give

milrinone

low afterload, give

vasopressor (NE)

low contractility, give

inotrope (dobutamine)

low contractility, low HR, low SVR, give

EPI

transplanted heart is

preload dependent

vasopressor for transplanted heart

phenylephrine

worsen LVOT

incr contractility decr preload decr SVR PPV labor

drugs worsen LVOT

ephedrine dobutamine epi

improve LVOT

decr contractility incr preload incr SVR

drugs improve LVOT

BB CCB

HOCM goals

decr LVOT decr ischemia avoid arrythmia

HOCM pregnancy labor analgesia

epidural

HOCM pregnancy vasopressor

phenylephrine fluids

dilated CM

LV dilation

preipartum CM

type of dilated CM

peripartum CM treatment

give diuretics give vasodilators

treat restrictive CM

ketamine no PPV avoid brady

cor pulmonale

RV enlargement can turn into RHF

cor pulmonale management

avoid hypoxia avoid hypercarbia avoid overnarcsq

open diastole

T M

open systole

P A

starling

incr preload = incr SV

starling overstrethcing

decr contractility decr SV

concentric hypertrophy

incr P

eccentric hypertrophy

incr V

LV failure

pulm edema

RV failure

lower edema

stenosis

normal HR mx preload mx afterload avoid myocardial depression

regurge

fast HR full mx preload forward SV decr SVR

outer pericardium

fibrous

inner pericardium

serous

small effusion stretfches

elastin

large effusion stretches

stiff collagen

inspiration causes (IVS shift)

incr RV filling shift IVS Left

pericarditis classified by

duration recurrence

acute peri

2-4 weeks

incessant peri

1-3 mo

chronic peri

> 3 mo

recurrent peri

4-6 weeks asymptomatic

pericarditis S+S

ST elevation PR depression chest pain incr inflammation

is pericarditis responsive to NTG

exudative

incr permeability

transudative

incr pressure to drive fluids

pulsus paradoxus

decr SBP on inspiration incr SBP on expiration

pleural effusion S+S

SoH orthopnea cough chest pain

pleural effusion primary diagnosis

echo

small pleural effusion

< 10 mm

mod pleural effusion

10-20 mm

large pleaural effusion

> 20 mm

tamponade S+S

pulsus paradoxus becks triad

becks traid

muffled heart sounds incr jugular distension hypotension

tamponade induction

ketamine

hemopericardium primary diagnosis

CVP TEE

treat hemopericardium

pericardiocentesis surgical drain w/window

pericardial decompression S+S

hypotension severe HF pulm edema

management pericardial effusion and constrictive pericarditis

avoid hypovolemia avoid PPV avoid decr SVR avoid hypoxemia min PIP/PEEP

commotio cordis

impact trauma R on T phenomena

who has increased ischemic risk

males

angina S+S

retrosternal chest pain screscnedo decrescendo pain

angina gold std diagnosis

coronary angiography via femoral

angina dermatomes

C8-T4

stable angina

no change over 2+ months

stable angina most common cause

atherosclerosis

stable angina diagnosis

stress test

what might be normal in stable angina

EKG

coronary steal drugs

adenosine dipyridamole

acute coronary syndrome common cause

focal disruption of plaque

STEMI S+S

incr CRP incr fibrinogen ST changes incr troponin C

when does troponin C elevate

w/in 3 hrs of MI

troponin I

> 40 ng/L

troponin T

men > 22 ng/L female > 14 ng/dl

when do yo unot need an ECHO for stemi diagnosis

with EKG diagnosis

treat stemi

BB reperfusion PCI

reperfusion starts within

30 mins of hospital (12 hrs of symptoms start)

PCI starts within

90 mins of hospital (12 hours of symptoms)

treat chronic NSTEMI

statins

treat acute NSTEMI

BB anithrombotics supp O2

drug eluting stent decreases

neointimal hyperplasia

reendothelialization takes

2-3 weeks

BMS reendothelialization

12 weeks

DES reendo

1 year

angioplasty wait for surgery

2-4 weeks

BMS wait for surgery

1-3 month

DES wait for surgery

6-12 mo

CABG wait for surgery

6-12 weeks

MACE risk 4 weeks post PCI

10%

MACE risk 31-90 days post PCI

MACE risk > 90 days post PCI

aspirin increase bleeding risk

1.5x

plavix + aspirin increases bleeding risk

2.25x

stop clopidogrel/ticagrelor

5 days

stop prasugrel

7 days

stop rivaroxaban

3 days

stop aspirin

6 days for high bleeding risk only

when can you give plts after clopidogrel

4 hrs

platelets are most effective given ____ hrs after clopidogrel

24+ hrs

DAPT

aspirin + Plavix

DAPT after angioplasty

2 weeks

DAPT after BMS

6 weeks

DAPT after DES

1 year

wait ____ days after MI for surgery

60+ days

MI with normal/high BP, give

NTG

MI w/normal/high BP and high HR, give

esmolol

obstructive

incr TLC incr RV decr FEV1 decr FVC decf FEV1/FVC ratio

obstructive ex

asthma CF bronchiectasis URI

URI are

viral

wait ____ from URI symptoms start for surgery

6 weeks

compliance =

C = V/P

severe asthma FEV1

FEV1 < 60%

severe asthma FEV1/FVC

decr > 5% FEV1/FVC

treat asthma on vent

incr I:E ratio (incr expiration time)

COPD FEV1/FVC

> 70%

mild COPD

FEV1 >=80%

mod COPD

50-80% FEV

sev FEV1

30-50% FEV1

very sever COPD

FEV1 < 30%

what BODE is bade

high BODE

BODE

BMI obstruction Dyspnea exercise

what decreases risk for intraop COPD

preop incentive spirometry

COPD on monitor

upslope capnography doesnt return to baseline

restrictive

normal - incr FEV1/FVC decr TLC decr RV decr RFEV1 decr FVC

mild restrictive

65-80% TLC

restrictive ex

pulm edma pneumo

mod restrictive

50-65% TLC

sev restrictive

< 50% TLC

DLCO in restrictive

decreased DLCO

pulm edema goal

optimize cardiorespiratory function

mild ARDS

paO2/FiO2 > 200

mod ARDS

paO2/FiO2 > 100

scoliosis

lateral

kyphosis

severe kyphoscoliosis

> 100 deg

lordosis

posterior

GHTN

BP > 139/89

preeclampsia treatment

delivery at term mild delivery at 37 weeks

HELLP

deliver at 34 weeks

ecclampsia

deliver if seizures dont stabilize

triad of death

hypothermia acidosis coagulopathy

previa

painless vaginal bleeding > 32 weeks

previa delivery

C section at 37 weeks

vasa previa

low lying fetal vessels

vasa previa management

bedrest: 30-32 weeks delivery: CS at 35 weeks

accreta

asymptomatic

accreta management

CS at 34 weeks

abruption managment

epidural if no fetal distress GETA for severe hemorrhage

most common cause of hemorrhage

uterine atony

uterine rupture

severe abdominal pain w/referred shoulder

uterine rupture management

immediate laparotomy

dehiscence

incomplete uterine division

dehiscence treatment

most likely c section

HOCM w/LVOT management

early epidural w/slow titration

HTN stage 1

130-139/80-89

HTN stg 2

140+/90+

ANP

atrial

BNP

ventrical

CNP

vasculature

secondary HTN causes

Cushings Hyperaldo Aorta coarctation Pheochromatoma S

1 kg = _____mmHG BP

1 kg = 1 mmHg

primary HTN treatment

thaizide CCB ACE ARB

secondary HTN treatment

loop diuretics K= sparing aldo antag BB alpha blocker

hold before surgery

ACE ARB

continue before surgery

CCB BB clonidine

how much fluid is bowel prep

cancellectomy

180+/110+

surgeries with high risk acute post op HTN

CAE AAA neck dissection craniotomy

mPAP

> 20 mmHg

1 wu

80 dynes/s/cm5

PVR =

PVR = (mPAP - PAWP)/CO

phtn management

avoid hypoxia avoid hypercarbia

hypercarbia causes

incr PVR

inotropy

contractility

chronotropy

dromotropy

conduction

bathmotropy

excitability