Final Flashcards
(97 cards)
1
Q
High velocity flow across a valve signifies
A
Stenosis
2
Q
6 Complications of PAC
A
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
Q
Issues with propofol with EP
A
Shorten or no effect on QT
4
Q
Monitor utility for ECG with imyocardial ischemia
A
QRST abnormality
Rhythm and conduction
5
Q
Advantages of internal jugular central venous cannulation
A
Accessible
Good landmarks
Straight shot for PAC
Less chance of pneumo
6
Q
On color Doppler blood flowing towards the transducer is what color
A
Red
7
Q
PAC provide indirect measurement of LV filling and CO but are (2 disadvantages)
A
Invasive
Associated with adverse events
8
Q
Clinical points of interest for radial cannulation
A
Preferred site
Ease of access
Low complication rate
9
Q
Pacer mode for SSS in absence of AVB or AF
A
AAI
10
Q
Strategies to minimize EMI during sg
A
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
Q
7 uses of TEE
A
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
Q
6 potential complications of arterial cannulation
A
- Infection
-Hemorrhage - Thrombosis- distal
ischemia - skin necrosis
- embolization (central and
Peripheral) - inaccurate pressure measurement
13
Q
4 complications associated with TEE
A
Esophageal perforation
GI hemorrhage
Oral damage
Misinterpretation
14
Q
Conscious sedation for EP/device procedures
A
Responsive pt
NC only
Versed, fentanyl, low dose propofol
15
Q
CVP is useful for trending _______ but not a reliable indicatior of _______
A
Trending intravascular volume
Not reliable indicator of LV filling
16
Q
Basic TEE incorporates ___ windows to perform assessment of cardiopulmonary function
A
11
17
Q
“X” and “Y” wave on CVP represent
A
Ventricular filling and diastolic collapse
18
Q
3 effects of electromagnetic interference (EMI) with PPM/ICD
A
Pacer/ICD sensing issues
Inappropriate anti-tachy therapies
Generator damage
19
Q
Floating PAC from RIJ
Do not float swan past
A
65cm
20
Q
5 indications for TEE
A
CP instability
Suspicion of LV dysfx
MI
Hypovolemia
PE
21
Q
Typically magnet may have what effect on PPM
A
Pace asynchronously
22
Q
Arterial waveform analysis dichroic notch represents
A
Aortic valve closure
23
Q
Arterial waveform analysis Ps represents
Pd represents
A
SBP
DBP
24
Q
Floating PAC from RIJ
Distance to RA
A
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
