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Flashcards in Final Deck (97):
1

High velocity flow across a valve signifies

Stenosis

2

6 Complications of PAC

Carotid/SC artery puncture/cannulation

Perf of RA, RV, or PA

Cardiac dysrhythmia

Heart block (RBBB)

Knotting of catheter

Improper tx based on data

3

Issues with propofol with EP

Shorten or no effect on QT

4

Monitor utility for ECG with imyocardial ischemia

QRST abnormality

Rhythm and conduction

5

Advantages of internal jugular central venous cannulation

Accessible

Good landmarks

Straight shot for PAC

Less chance of pneumo

6

On color Doppler blood flowing towards the transducer is what color

Red

7

PAC provide indirect measurement of LV filling and CO but are (2 disadvantages)

Invasive

Associated with adverse events

8

Clinical points of interest for radial cannulation

Preferred site
Ease of access
Low complication rate

9

Pacer mode for SSS in absence of AVB or AF

AAI

10

Strategies to minimize EMI during sg

Short burst of mono polar cautery

Ground pad should not be placed at vector with device

TENS and cells may interfere with unipolar devices

11

7 uses of TEE

Ass. Heart fx and volume

Eval MI

Assess valve anatomy and fx

Eval aorta

Detect intracranial defects

Eval pericardial effusions

Detect intracardiac air, clots, masses

12

6 potential complications of arterial cannulation

- Infection
-Hemorrhage
- Thrombosis- distal
ischemia
- skin necrosis
- embolization (central and
Peripheral)
- inaccurate pressure measurement

13

4 complications associated with TEE

Esophageal perforation

GI hemorrhage

Oral damage

Misinterpretation

14

Conscious sedation for EP/device procedures

Responsive pt

NC only

Versed, fentanyl, low dose propofol

15

CVP is useful for trending _______ but not a reliable indicatior of _______

Trending intravascular volume

Not reliable indicator of LV filling

16

Basic TEE incorporates ___ windows to perform assessment of cardiopulmonary function

11

17

“X” and “Y” wave on CVP represent

Ventricular filling and diastolic collapse

18

3 effects of electromagnetic interference (EMI) with PPM/ICD

Pacer/ICD sensing issues

Inappropriate anti-tachy therapies

Generator damage

19

Floating PAC from RIJ

Do not float swan past

65cm

20

5 indications for TEE

CP instability

Suspicion of LV dysfx

MI

Hypovolemia

PE

21

Typically magnet may have what effect on PPM

Pace asynchronously

22

Arterial waveform analysis dichroic notch represents

Aortic valve closure

23

Arterial waveform analysis Ps represents

Pd represents

SBP

DBP

24

Floating PAC from RIJ

Distance to RA

20cm

Provides CVP trace

25

3 disadvantages of US guided arterial cannulation

Infection if poor sterile technique

Additional training required

Equipment costs

26

PPM codes by letters

1- paced
2- sensed
3- response to sensing

27

Advantages of femoral central venous cannulation

High success

Ease of placement

Compressible

No risk of pneumo

Trendelenberg not necessary

28

Single best monitor of heart function and perfusion of vital organs

Noninvasive blood pressure monitor

NIBP

29

6 indications for pacemaker

Symptomatic bradycardia

Heart block

Heart failure

Tachycardia-Brady syndrome with AF

Heart transplant with bradycardia

Temp. Pacer to support hemodynamics

30

Utility of advanced BP monitoring (TEE)

Continuous real time BP monitoring

continuous CO using pulse

Analysis of waveform

31

Femoral cannulation for a line clinical points of interest

Easy access

More accurate in low flow states

More central

Need longer catheter

32

Pacer mode for third degree heart block with afib in the OR

VOO

33

6 indications for use of pacing PAC

SA dysfx or symptomatic bradycardia

Second degree type 2 AVB

Complete heart block

Dig toxicity

Need for AV sequential pacing

Left BBB

34

2 issues with TEE

Manpower

TTEE training

35

Points of interest for brachial cannulation for a line

Median nerve damage potential

Clotting

36

6 factors affecting accuracy of TD CO

Inaccurate injectate temp or volume

Rapid volume infusion during injection

Respiratory cycle

Inaccurate computation constant

Thermal instability post CPB

37

6 indication for invasive BP monitoring

- continuous real time BP
- anticipated CV instability
- intentional pharm or
mech CV manipulation
- failure of indirect measurement
(Obesity)
- supplementary diagnostic clues
- ABG sampling

38

The % sensitivity for detecting myocardial ischemia using leads II and V5

80%

39

Disadvantage of femoral central venous cannulation

Sepsis

Increased risk of thrombosis and infection

Difficult to float PAC

Potential for retroperitoneal hemorrhage

Pt must be immobile

40

Disadvantages of internal jugular central venous cannulation

Carotid puncture

Difficult if fat/obese neck

Increased infection rate

41

Most common side for IJ central venous cannulation

Right

42

TEE provides (3 advantages)

Direct assessment of LV filling

Valve/cardiopulmonary function

Minimally invasive

43

6 indication for PA catheter

- LV dysfunction ***

- symptomatic valve disease ***

- vascular sg with clamp of major artery ***

- 2 vessel disease/angina w/i 48 hrs

- severe HTN w/ hx of angina

- large operation with intravascualr volume change

44

Floating PAC from RIJ

Distance to pulmonary artery

40cm

45

Advantages of subclavian cannulation for central venous cannulation

Accessible

Good landmarks

No restriction in C-collar, trach

Potential for lower infection rate

46

Three clinical parameters that may be assessed with analysis of arterial waveform

Ejection velocity

SV

Systole/diastole

Pulse pressure variation

47

3 relative contraindications of PAC

Severe arrhythmia

Coagulopathy

Newly inserted pacemaker wires

48

Pacer mode for third degree heart block with intact atrial contraction in OR with SVT

DVI

49

“C” wave of CVP represents

Isovolumic ventricular contraction

(Prior to AV opening)

50

Issues with Ketamine in EP

Prolongs QT and AV conduction

Sympathetic activation

51

5 measurements obtained by doppler

CO

PAP

EF

Gradient across valves

Valve area

52

In unipolar leads (older) where is anode and cathode

Pacer is anode

Cath tip is cathode

53

Floating PAC from RIJ

Distance to RV

30cm

54

ICD tachytherapies.


Rate ________ receives overdrive pacing

Rate _________ recieves defibrillation

150-180

>180

55

_________ enables quantitative assessment of heart and valve function by providing _____ and _____ of blood flow

TEE

Doppler ultrasound

Direction and velocity

56

Limitations of using CVP as index of ventricular filling

Decreased RV compliance or fx

Tricuspid valve disease

Positive pressure ventilation

Rapid volume infusion

57

_________ Doppler measures flow in a specific sample

Pulse wave

58

Disadvantages fo external jugular central venous cannulation

Low success

Kinks at SC

High incidence of thrombosis

Difficult to maintain sterile dressing

59

Advanced blood pressure monitoring provides indirect measurement of (3)

Stroke volume

Pulse pressure variation

Cardiac output

60

7 causes other than ischemia that may affect ST segment

LVH or RVH (strain)
Conduction defects
Drugs (dig, quinidine)
Electrolyte abnormalities (K,Ca, Mg)
Pericarditis, pericardial effusion
Intracranial hemorrhage
Hypothermia

61

7 factors affecting cardiac filling pressures

- decreased/increased ventricular compliance
- MI
- valve dysfx
- increased filling (volume overload)
- decreased volume (blood loss)
- increased afterload
- lung compliance

62

General anesthesia for EP/device procedures

LMA, ETT

Inhalation vs TIVA

63

Pacer mode for AVB and SSS

Also pt with LV dysfx and LVH that need coordination of atria and ventricles for adequate CO

DDD

64

“A” wave on CVP represents

Atrial contraction

65

Issues with Dexmedetomidine EP

Sympatholytic effect in large doses

66

Temporary pacer mode used sometimes during surgery

VOO

67

Dp/Dt *change in pressure / change in time
Represents

Contractility

68

5 benefits of US guided arterial cannulation

Greater success on first attempt

Fewer overall attempts

Improved pt comfort

Useful in low or non pulsating flow

Useful in non-palpable pulse

69

Disadvantages of subclavian central venous cannulation

Pneumothorax

Effusion

More difficult that IJ

Noncompressible

70

Deep sedation for EP/Device procedures

Unresponsive

Versed, fentanyl, propofol (>60mcg/kg/min)

71

Segments of LV are identified by TEE and ______ analyzed using ________

Segmental wall motion analyzed

Midesophageal and transgastric windows

72

Typical effect of magnet on ICD

Turn off anti-tachycardia and defibrillation therapy

Will not turn back on without reprogramming

73

Arterial waveform analysis

As represents

Area under systolic portion of curve

Proportional to stroke volume

74

Intraop monitoring for CEIDs

External defibrillator available

External pads if sg makes access difficult

Plethysmography mandatory

ECG with pacing mode

Magnet must be available

75

Calculating EF with TEE

EF= (EDA-ESA) / EDA

76

5 indicators for ICD

Previous or inductively VF/VT

EF <30% with prior MI (>40days post MI)

Long QT syndromes w/ inductively VT

Hypertrophic cardiomyopathy

Pt awaiting heart transplant

77

Degree of stenosis calculated value for mild and moderate to severe stenosis

< 36mmHg is mild

>36 mmHg is moderate to severe

78

Monitor utility for PAC with myocardial ischemia

Compliance

CO

Volume

SVR

79

Complication of central venous line

- accidental arterial puncture
- cath induced dysrhythmia
- infection
-misinterpretation of data
-pneumo/hemothorax
- airway compromise
- air embolus
- tracheal puncture
- cath wire shearing/foreign body
- thromnophlebitis
- tamponade
- nerve injury

80

Awake anesthesia for EP/device procedures

No sedation

Propofol infusion for femoral access only

81

Color Doppler blood flowing away from the transducer is what color

Blue

82

Pacer mode for AVB and atrial arrhythmias

VVI

83

Floating PAC from RIJ

Distance for PAC to wedge (PCWP)

50-55cm

84

6 potential complications with ICD insertion

Cardiac perforation

Esophageal perforation

Cardiac tamponade

Dysrhythmia

Mapping/ablation errors

Respiratory variation

85

Limitation to use of advanced blood pressure monitoring involve the effects of (4))

Tidal volume

Vasopressin

right heart fx

Dysrhythmia

86

Discrepancies causing PCWP < LVEDP

Non compliant LV

Aortic regurg (premature closure of mitral valve)

LVEPD > 25 mmHg

87

“V” wave on CVP represents

Ventricular contraction and systolic filling of atrium

88

3 absolute contraindications for PAC

Tricuspid or pulmonary stenosis

RA or RV mass

Tetralogy of Fallot

89

Advantages of external jugular central venous cannulation

Superficial location

Safety

Compressible

Ease of insertion

90

5 clinical uses of PAC data

Measure CO & optimize perfusion

Detect, tx, and trend MI

Measure and optimize ventricular preload and volume in sg w/ lg volume shifts

Measure and optimize ventricular preload and volume in sg during aortic cross clamp

Detect, tx, and trend valvular dysfx

91

8 clinical/pt indications for invasive BP monitoring

- Trauma/shock/MOF
- IC, cardiac, thoracic,
vascular sg
- massive fluid shift/blood loss
- deliberate hypotension
- pulmonary disease, freq ABG
- recent MI, USA, sig 2 vessel disease
- decreased LV fx
- need more frequent BP

92

3 functions of ICD

Pacemaker (routine or CRT)

Defibrillator
- anti-tachycardia pacing
-defibrillation

93

__________ Doppler measures all flow along a line

Continuous wave

94

Pacer mode for third degree heart block with intact atrial contraction in OR

DOO

95

5 clinical applications of TEE

Wall motion and compliance (ischemia)

Volume, contractility

96

Discrepancies causing PCWP>LVEDP

- PPV
- PEEP
- COPD
- increased intrathoracic pressure
- increased PVR
- LA myxoma
- MV disease

97

TEE utilizes _________ to sound and requires manipulation to acquire ______ to US beam

Acoustic impedance

Perpindicularity