Hall Ch11

Question 1

What type of patients should receive antibiotic prophylaxis for infective endocarditis?

Answer 1

Pts undergoing selected dental procedures with prosthetic valves, previous infective endocarditis, congenital heart disease, heart transplant with valvulopathy

Question 2

Most sensitive indicator of left ventricular myocardial ischemia

Answer 2

Wall motion abnormalities on echocardiogram

Question 3

2500 cc/min of oxygen consumption equates to how many METs?

Answer 3

10 METs. 1 MET equals energy expended during 1 minute of rest

Question 4

Common reason for pulmonary artery pressure to suddenly increase during CPB

Answer 4

Distal migration of pulmonary artery catheter into a wedge position. Another reason is inadequate ventricular venting leading to ventricular distension

Question 5

During CPB, facial or scleral edema is a sign of

Answer 5

Malposition of venous cannula

Question 6

During CPB, unilateral facial blanching is a sign of

Answer 6

Improper positioning of aortic cannula

Question 7

How does transposition of great vessels affect inhalation induction?

Answer 7

Slower than normal

Question 8

How does transposition of great vessels affect IV induction?

Answer 8

Faster than normal

Question 9

Fontan procedure (anastomosis of right atrial appendage to pulmonary artery treats which congenital cardiac defects?

Answer 9

Tricuspid atresia, pulmonary atresia, pulmonary stenosis, hypoplastic left heart

Question 10

Tissue metabolic rate is reduced by how much for each degree body temperature is lowered?

Answer 10

5-8% for every degree of body temp lowered. CPB

Question 11

Effective deflation of IABP occurs when?

Answer 11

Just before ventricular systole or midpoint of QRS complex

Question 12

Effective inflation of IABP occurs when?

Answer 12

Immediately after closure of aortic valve or after T wave

Question 13

Effects of afterload reduction on Tetralogy of Fallot

Answer 13

Increases right to left shunt which worsens systemic hypoxemia

Question 14

Afterload reduction is beneficial for which cardiac conditions?

Answer 14

Aortic insufficiency, mitral regurgitation, congestive heart failure, patent ductus arteriosus

Question 15

Protamine is a compound isolated from?

Answer 15

Fish sperm

Question 16

Dose of protamine to reverse heparin

Answer 16

1.3 mg of protamine for each 100 units of heparin

Question 17

Administering protamine to pt who hasn’t received heparin results in?

Answer 17

Anticoagulant effect by binding to platelets and soluble coagulation factors. Hypotension if given rapidly because of histamine release.

Question 18

3 factors that determine myocardial O2 demand from most to least important

Answer 18

Heart rate > afterload > preload

Question 19

Pulsus paradoxus is sign of

Answer 19

Cardiac tamponade, severe airway obstruction, RV infarction. (Inspiratory fall in SBP > 10 mmHg)

Question 20

Pulsus parvus (diminished pulse wave) and pulsus tardus (delayed upstroke) are signs of

Answer 20

Aortic stenosis

Question 21

Pulsus alternans (alternating smaller and larger pulse waves) is a sign of

Answer 21

Severe LV dysfunction

Question 22

Bisferien pulse (pulse waveform with 2 systolic peaks) is a sign of

Answer 22

Significant aortic regurgitation

Question 23

Drugs that can be administered down ETT?

Answer 23

ALONE: Atropine, Lidocaine, Oxygen, Naloxone, Epinephrine. Vasopressin too

Question 24

Amiodarone is what class of antidysrhythmic?

Answer 24

Class 3, prolongs action potential and repolarization

Question 25

Amiodarone metabolism

Answer 25

Liver

Question 26

Amiodarone half life

Answer 26

58 days

Question 27

Amiodarone excretion

Answer 27

Bile

Question 28

Lidocaine is what class of antidysrhythmic?

Answer 28

Class 1B

Question 29

Lidocaine metabolism

Answer 29

Liver

Question 30

Lidocaine excretion

Answer 30

Urine 90%

Question 31

Lidocaine half life

Answer 31

1-8 hrs

Question 32

Antidysrhythmic drug that may cause hypothyroidism or hyperthyroidism

Answer 32

Amiodarone, a benzofurane derivative with similar chemical structure to thyroxine

Question 33

Equation for SVR

Answer 33

SVR = 80 * ((MAP-CVP)/CO)

Question 34

Beta 2 stimulation effects include...

Answer 34

``` Relaxation of vascular, airway, and uterine smooth muscle tone. Glycogenolysis Gluconeogenesis Insulin secretion Renin secretion ```

Question 35

Which volatile agent causes the most direct myocardial depression?

Answer 35

Halothane

Question 36

What is halothane's effect on SVR?

Answer 36

Unchanged

Question 37

What is halothane's effect on heart rate?

Answer 37

Decrease in heart rate.

Question 38

MC form of inherited long QT syndrome

Answer 38

Romano Ward

Question 39

Treatment for Romano Ward (long QT)

Answer 39

Left stellate ganglion block which shortens QT interval and temporarily abolishes the imbalance between right and left sides of the sympathetic nervous system that may play a role in the etiology of the syndrome

Question 40

Why is left stellate ganglion block used to treat long QT syndrome?

Answer 40

Long QT syndrome is thought to be caused by a left greater than right sympathetic activity so left stellate ganglion block will balance the activity

Question 41

What percent of cardiac output is dependent on atrial kick?

Answer 41

25%

Question 42

An arterial waveform with 2 systolic peaks is a sign of what cardiac disorder?

Answer 42

Severe aortic regurgitation. 2nd peak is a reflected pressure wave from the periphery

Question 43

Which volatile anesthetic provides most stable hemodynamics for hypertrophic cardiomyopathy

Answer 43

Halothane

Question 44

What type of induction would provide most stable hemodynamics for tetralogy of Fallot?

Answer 44

Ketamine, which maintains SVR and minimizes right to left shunt

Question 45

Under max stress, how much cortisol is produced per day?

Answer 45

150 mg

Question 46

Normal resting myocardial O2 consumption

Answer 46

8-10 mL/100g/min or 10% of total body consumption of O2

Question 47

Normal resting coronary artery blood flow

Answer 47

75 mL/100g/min or 225-250 mL/min or 4-5% of cardiac output

Question 48

Known risk factors for pulmonary artery rupture with PA catheter

Answer 48

``` Elderly Anticoagulation Hypothermia (stiffens catheter) Migration Prolonged wedge time ```

Question 49

Why are IDDM pts at risk of allergic rxn to protamine with certain types of insulin?

Answer 49

These pts have been exposed to protamine which is in some types of insulin like NPH and PZI

Question 50

Half life of heparin

Answer 50

1.5 hrs

Question 51

Medication that inhibits breakdown of adenosine so dose of adenosine should be reduced

Answer 51

Dipyridamole

Question 52

The reason for measuring both bladder and PA catheter temperature

Answer 52

Helps evaluate adequacy of rewarming after CPB

Question 53

Best TEE view to monitor myocardial ischemia

Answer 53

Transgastric mid papillary left ventricular short axis view

Question 54

Most frequent initial rhythm in a witnessed sudden cardiac arrest

Answer 54

Ventricular fibrillation

Question 55

Mechanism of action of milrinone

Answer 55

PDE3 inhibitor

Question 56

Non immune HIT is which type?

Answer 56

Type I, transient and clinically insignificant

Question 57

Mechanism of action of hirudin

Answer 57

Direct thrombin inhibitor

Question 58

HIT type 2 is where a complex is formed consisting of?

Answer 58

Antibody, heparin, and platelet protein factor 4. This complex bonds to endothelial cells which then stimulate thrombin production

Question 59

Mechanism of action of clopidogrel

Answer 59

Noncompetitive irreversible inhibition of ADP receptor P2Y12.

Question 60

Type of WPW rhythm that is amenable to rate control

Answer 60

Narrow complex tachycardia, conduction is orthodromic (conduction passes through AV node)

Question 61

Type of WPW rhythm that is NOT amenable to rate control

Answer 61

Wide complex tachycardia, antidromic conduction. Rx is procainamide

Question 62

Procainamide is what class of antidysrhythmic

Answer 62

Class 1A, used to treat antidromic wide complex tachycardia in WPW patient

Question 63

What to do if pacemaker is set to DOO mode at 70 bpm and under GA the patient's native HR increases to 85?

Answer 63

Give beta blocker to avoid R on T phenomenon.

Question 64

Main advantage of milrinone over amrinone in long term use is lack of what side effect?

Answer 64

Thrombocytopenia

Question 65

Dromotropy

Answer 65

Conduction of impulses along conduction tissue

Question 66

Bathmotropy

Answer 66

Muscular excitation in response to a stimulus

Question 67

Lusitropy

Answer 67

Myocardial relaxation or diastole

Question 68

At what lung volume is pulmonary vascular resistance the least?

Answer 68

FRC

Question 69

Cardiac risk factors for elective noncardiac surgery

Answer 69

``` High risk surgery CHF Ischemic heart disease Cerebrovascular disease IDDM Creatinine > 2mg/dL ```