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Final Flashcards

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1
Q

Heart failure classification

Comfortable at rest
Slight limitation of physical activity

A

Class II mild

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2
Q

Heart failure classification

Marked limitation of physical activity

Less than ordinary activity results in fatigue, palpitation, or dyspnea

A

Class III. Moderate

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3
Q

Heart failure classification
Symptoms of cardiac insufficiency at rest

Unable to carry out any physical activity without discomfort

A

Severe

Class IV

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4
Q

Type of cardiomyopathy

Systolic dysfunction

Eccentric LV enlargement

A

Dilated (congestive) cardiomyopathy

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5
Q

Type of cardiomyopathy

Diastolic dysfunction

Concentric hypertrophy

Dynamic outflow obstruction

A

Obstructive cardiomyoptahy

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6
Q

Abnormal diastolic dysfunction.

Abnormal E:A

A

Restrictive cardiomyopathy

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7
Q

Failure of LV leads to increased ____________

A

LVEDP

LVH

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8
Q

Best vasopressor for heart failure patient

A

Ephedrine better than phenylephrine

NE better than ephedrine

Vasopressin if cant get NE

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9
Q

Highest mortality post transplant is when

A

Within first 6 months

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10
Q

90% of heart transplant is due to

A

Idiopathic or ischemic dilated cardiomyopathy

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11
Q

6 contraindications to heart transplant

A

Severe elevation in PVR

Psych factors/compliance

Irreversible renal, hepatic, pulmonary function

Co-existing disease with poor prognosis

Uncontrolled malignancy

Active infectious process

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12
Q

Minimize ischemic time of donor heart. Usually less than

A

4 hours

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13
Q

Donor heart is denervated and electrical activity

ECG appearance

A

Cannot cross suture line

2 P waves

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14
Q

Due to denervation which sympathomimetic have no effect

A

Indirect bc loss of SNS, PNS innervation to heart

Use direct: epi, NE, isoproterenol

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15
Q

Management of RV failure after transplant (4)

A

Optimize preload (starling pyramid)

Provide early inotropic support

Maintain low PVR

Consider mechanical support (IABP, RV assist device)

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16
Q

3 drug classes ot maintain low PVR

A

Nitrates

Prostaglandins

Nitric Oxide

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17
Q

Post transplant considerations for anesthesia

A

No hemodynamic response to DL and light anesthesia and pain

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18
Q

Induction in heart failure patients (3)

A

Slower induction

Maintenance of compensatory mechanisms

More potent vasopressors

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19
Q

4 indications for VADs

A

Heart failure

Circulatory support during surgery

Recovery from MI

Destination therapy

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20
Q

LVADs are dependent on

A

Reasonable RV function

Normal PAP

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21
Q

Often used to improve pulmonary hypertension and RV function

A

Epoprosterenol (Flolan)

Nitric oxide

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22
Q

TEE findings that contraindicated LVAD placement

A

AI

PFO

VSD

ASD

Severe RV dysfunction

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23
Q

Unique considerations of VAD hemodynamics

A

Inconsistent LV ejection

Use MAP instead of SBP/DBP

Optimize RV function

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24
Q

Current durable VADS have _______ flow

A

Non-pulsatile continuous flow

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25
What 2 things decrease LVAD flow
Hypovolemia and increased afterload
26
TEE exam after LVAD implantation watch for
SUCKDOWN Need adequate preload
27
Post-implantation management of LVAD includes
Anticoagulation Avoid high pump speeds
28
Prior to surgery should assess
Patient function End organ damage Doppler/US available
29
Anesthesia plan for pt with LVAD
Faster fuller vasodilation
30
Post implant LVAD hemodynamic goals MAP Pulse pressure
MAP 70-80. Avoid >90mmHG PP 10 mmHG
31
No _________ for LVAD patients
Spinal or epidural
32
Anesthesia for LVAD patients
Avoid hypovolemia and pulmonary hypertension
33
If in doubt about pump function during arrest you should do what?
Listen for humming
34
ICD settings intraop for pt with LVAD
Rate of 100 Tachytherapies off
35
Parameters of VAD console Pump flow Pump speed Pump power Pulsatility
Flow 4-6 lpm Speed 8000 Power 4-8 Pulsatility 4-6
36
Biggest risk of VADs
Infection Stroke
37
Left to right shunts aka
Acyanotic
38
3 congenital defects associated with left-to-right shunts
ASD VSD PDA
39
Right-to-left shunts aka
Cyanosis
40
Common cyanotic congenital defects
Tetralogy of Fallot Transposition of great arteries Single ventricles
41
Defect which typically allows parallel circulation physiology to exist
TGA and turn us arteriosus
42
4 classes of meds used in medical mgmt of LV failure in perioperative period
Diuretics Digoxin ACE inhibitors Beta blockers
43
3 potential causes of pulmonary hypertension in pt with existing or repaired CHD
Presence of long-standing large nonrestrictive defects Elevated LVEDP, PAP, or PA stenosis Decreased O2 sat
44
Predictors of mortality with Eisenmenger syndrome
``` Syncope Age at presentation Poor functional class Atrial dysrhythmias Elevated RAP Low O2 sat Severe RV dysfunction Trisomy 21 ```
45
Findings in Eisenmenger’s Syndrome
Loud pulmonic 2nd heart sound PT murmur EKG RVH Impaired exercise tolerance Palpitations Hemoptysis Syncope Heart failure
46
Primary goals of anesthetic management in patient with pulmonary hypertension
Minimize increases in PVR Maintain SVR
47
Factors increasing pulmonary output
Decreased PVR Increased SVR
48
Causes of decreased PVR
Hypocapnia Pulmonary vasodilator
49
Causes of increased SVR
SNS stimulation Vasoconstrictor Hypothermia
50
Factors increasing systemic output
Increased PVR Decreased SVR
51
Causes of increased PVR
Hypoxemia Hypercapnia High hematocrit PPV Cold Metabolic acidosis Alpha-adrenergic stimulation
52
Causes of decreased SVR
Vasodilators Spinal/epidural Deep GETA Hyperthermia
53
7 measures to prevent and treat acute pulmonary hypertension
Hyperventilate (normocapnia) Correct acidosis Avoid SNS stimulation Normothermia Minimize intrathoracic pressure Inotropic support Inhaled nitric oxide
54
Coagulation alterations in pt with cyanotic heart disease that may lead to coagulopathy and/or thrombosis
Low levels of vit-k dependent clotting factors, VWF, factor V (elevated INR)
55
Ventricular dysrhythmias are most frequently encountered in patiens with
Significantly decreased RV or LV function Acute hypoxemia
56
Supraventricular dysrhythmias occur in
20-45% of pt with previous atrial surgery
57
Dilated cardiomyopathy typically involves
Systolic dysfunction Eccentric hypertrophy
58
Obstructive cardiomyopathy typically involves
Diastolic dysfunction Concentric hypertrophy
59
Restrictive cardiomyopathy typically involves
Diastolic dysfunction Abnormal filling
60
Induction in heart failure patients involves
Slower induction Maintenance of compensatory mechanisms More potent vasopressors (ephedrine, NE, vasopressin)
61
Indications for VADs
Heart failure Circulatory support during surgery Recovery from MI Destination therapy
62
LVADs are dependent on
reasonable RV function Normal PAP
63
2 drugs often used to improve pulmonary hypertension and RV function
Epoprosterenol (Flolan) Nitric Oxide
64
TEE findings which may contraindicated LVAD
AI PFO VSD ASD Severe RV dysfunction
65
Unique considerations of VAD hemodynamics
Inconsistent LV ejection Use of MAP exclusively Optimizing RV function
66
Post implant management of LVAD includes
Anticoagulation Avoid high pump speeds (<9800rpm)
67
Prior to surgery should assess
Patient function End organ damage Have doppler/US available
68
Avoid what with LVAD
Hypovolemia Pulmonary HTN CPR but defibrillated as needed
69
If in doubt about pump function during arrest do what
Listen for humming of motor
70
Biggest risks of LVAD
Infection Stroke
71
ASD large shunt when
>20mm
72
Risks with ASD
Pulmonary blood flow increased Atrial dysrhythmias Emboli stroke Pulmonary HTN
73
Effects on heart of ASD
RV enlargement
74
VSD closure typically for defects >
5mm
75
Risks of VSD
Endocarditis AI
76
Coarctation of aorta results in
Chronic pressure overload of LV (compensatory hypertrophy) Always hypertensive
77
Most common cyanotic congenital heart disease
Tetralogy of Fallot
78
Even after tetralogy of Fallot corrected continue to have
Hypoxemia RV dysfunction
79
Tetralogy of Fallot associated with what dysrhythmias
Ventricular
80
4 components of tetralogy of Fallot
Narrowing PA Thickening RV Displacement of aorta over VSD VSD
81
Blalock-Taussig shunt considerations
Relieves poor oxygenation symptoms Affects BP and pulse ox on operative side
82
Palliative repair for single ventricle
Fontan repair
83
3 congenital defects associated with L to R shunt in adult
ASD/VSD Coarctation of aorta Congenital aortic valve disease Correction of transposition of great vessels Epstein’s abnormality of tricuspid

CV Anesthesia (4 decks)

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