Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiac > Heart Rotation Questions - General > Flashcards

Heart Rotation Questions - General Flashcards

1
Q

When do we bolus heparin and what is the dose

A

300-500 units/kg of patients weight

Prior to cannulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Protamine reversal dosing

A

1mg for every 100 units of heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why do we use insulin for CPB?

A

Bc insulin resistance occurs when the body temp drops ➡️ hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do you need to redose during the rewarming phase? (3)

A

Benzos, narcs, and NMBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is cardioplegia?

A

A potassium solution administered by the perfusionist to arrest the heart for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Difference between anterograde and retrograde cardioplegia cannulation

A

Anterograde > placed in ascending aorta b/t aortic valve and cross clamp to deliver cardioplegia down the coronary arteries

Retrograde > placed into the coronary sinus and delivers cardioplegia into the coronary veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Valves of the heart; how many leaflets do each have?

A

Tricuspid, pulmonic, mitral, aortic

Mitral is the only one that has 2 leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most diseases of the aortic valve are due to what?

A

People being born with a bicuspid aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Coronary Artery Anatomy:

A

Left Main spilts into Left circ & LAD

Right Main splits into marginal and right posterior descending artery (PDA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do TEGS test?

A

The efficiency of blood coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How many phases of diastole and what are they?

A

(1) > Isovolumetric relaxation
(2) > Rapid filling phase
(3) > slow filling “diastasis”
(4) > final filling during atrial systole - atrial kick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does heparin work?

A

It binds to Antithrombin III to inhibit the conversion of fibrinogen to fibrin which prevents fibrin from participating in clot formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What pathway(s) does Heparin work on?

A

Intrinsic and Final Common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does protamine work?

A

It neutralizes heparin
>heparin is a negatively charged acid + protamine is a positively charged base
> they bind together and neutralize out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F- protamine technically also has an anticoagulant effect

A

True - protamine overdose will result in increased ACT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

3 contraindications to protamine vs 3 cautions

A

3 contraindications > allergy, vasectomy, NPH insulin users
3 cautions > pulmonary HTN, previous exposure to protamine, previous CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 types of reactions to protamine

A

Type 1 = anaphylactic
>IgE mediated reaction where mast cells release histamine
> previous exposure results in an antigen (foreign protein) that stimulates the production of antibodies against that foreign protein. (“Pt develops antibodies from a previous exposure”)
> when body is exposed again to this antigen, it attacks and causes the mass histamine release > hypotension
>NOT dose dependent

Type 2 = anaphylactoid
>Immune mediated reaction where mast cells release histamine
>dose dependent

Type 3 = pulmonary HTN and RV failure
> Protamine binds to heparin, thromboxane is released > pulmonary vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

5 things to look for when giving protamine

A
  1. Allergic reaction
  2. Pulmonary HTN
  3. Hypotension
  4. Bradycardia
  5. Bronchoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment for any adverse reactions to protamine?

A

Epi is the best treatment for each reaction, each for different reasons

Type 1 & 2 (anaphlyactic & anaphylactoid)
>Epi- good for it’s mast cell stabilizing properties, also increases afterload, vascular tone, & pulmonary vasodilation)

Type 3 (pulmonary vasoconstriction)
> Epi- dilates the pulmonary vasculature, increases CO, contractility, and HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aortic insufficiency anesthetic goals:

A

Full, Fast, Forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Aortic Stenosis: normal AV vs severe AS

A

Normal AV = 2.5-3.5cm
Severe AS = <0.8 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mitral Stenosis:
Goals:
Normal valve area:
Severe MV stenosis

A

-Full, slow (more time for LV filling), constricted
-normal valve area 4-6cm
-Severe MV stenosis < 1cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Anesthetic goals for mitral and aortic regurgitation/insuffiency

A

FULL , Fast, Forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

CPP calculation

A

Aortic diastolic pressure - LVEDP (or PAOP)

-I think I saw pulmonary artery diastolic pressure can be used as a surrogate for LVEDP but is PADP the same as PAOP?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Induction goals for patients with cardiac tamponade
1. Increase CO by increasing HR, decreasing afterload, and decreasing right atrial pressures *Fast, Full, Right (tachy, hypervolemia, increased SVR) - dont get this , decrease afterload but increase SVR? 2. Maintain spontaneous ventilation as long as possible - the negative intrathoracic pressure with inspiration helps draw volume into the RA and aid in maintaining CO; once PPV occurs, the positive intrathoracic pressure reduces preload and can cause hemodynamic collapse in this patient
26
Normal Tricuspid valve area
7-9cm
27
Normal Pulmonic valve area
2.5-4cm
28
What else will you do if the surgery involves the aortic arch? (2)
1. Deep hypothermia protocol - 15-20 degrees for cerebral protection 2. B/L A-lines
29
What is the coronary sinus? Where is it located
A Large vein responsible for collecting deoxygenated blood from the myocardium (muscle) and depositing it into the RIGHT atrium Located posteriorly b/t right atrium and ventricle
30
Is the coronary sinus the only drainage system of the heart?
No- coronary sinus drains deoxygenated blood into RA The Thebasian veins and anterior cardiac veins drain deoxygenated blood into the LA (anatomic shunt)
31
Why do we do radial a-lines over brachial?
Lower complications (bleeding/hematoma)
32
What are the 3 branches off the aortic arch?
“I Can Ski” Innominate (Brachiocephalic) > Right SC & Right common carotid Common Carotid (Left) Subclavian (Left)
33
What is your major concern with acute pulmonary vasoconstriction/pulmonary HTN?
Right heart failure
34
How does Amicar work?
It prevents the breakdown of clots by inhibiting the conversion of plasminogen to plasmin (Plasmin is needed to break down fibrin/clots) (On the other side, t-PA and streptokinase enhance the conversion of plasminogen to plasmin, accelerating the breakdown of clots)
35
Why do we give Amicar on bypass?
It prevents the breakdown of clot formation intraop which decreases the risk for bleeding
36
What is plasmin? What does it do?
It helps break down fibrin (clots)
37
What happens in sepsis physiologically? Why do you have massive vasodilation? What will you see clinically?
An exaggerated inflammatory response to bacteria >activation of complement system and release of a ton of inflammatory mediators such as cytokines & nitric oxide > which dilates the vessels dropping your SVR systemically > hypotension >inflammatory mediators and ROS injure the vessels, causing the vessels to leak >accumulation of fluid into the tissues worsens tissue perfusion >signals further vasodilation (nitric oxide and more inflammatory mediators) to try and improve blood flow >anaerobic metabolism leads to acidosis, impairs heart contractility, further reducing CO & BP
38
What does cellsaver not have? Why?
Clotting factors It undergoes a washing process that removes heparin and clotting factors
39
Why do we mainly take autologous blood at the start of some cardiac cases?
Bc cellsaver washes the blood of clotting factors
40
Which organs have the hardest time on bypass?
All of them? Lol ; protective strategies for brain and kidneys Lot of evidence talking about inflammatory lung injury with CPB; older people with pre-existing lung disease are of higher concern with postop resp vailure. The pancreas doesn’t do well with non-pulsatile flow > decreased insulin secretion > no insulin to get glucose into the cells > hyperglycemia
41
Contraindications for swan (3)
1. Clot/mass 2. Endocarditis - vegetations on the valve can break off and cause a PE or stroke 3. LBBB- can send them into CHB
42
Hemodynamic management of HOCM
So of the hypertrophy of the intraventricular septum causes a LVOT - we treat it similarly to AS -Need to maintain a full ventricle is key to decrease the LVOT -increase preload -Slower HR to improve diastolic filling -Maintaining SR & atrial kick -Maintaining afterload *main difference is you want to decrease contractility - the more profound the contraction of the hypertrophied ventricle = worsened LVOT obstruction
43
Hemodynamic management of CAD
Avoid tachycardia > it increases o2 demand while reducing supply *add more
44
What is the catheter called that you put in the large port of the IJ?
Cordis
45
Where should the brown EKG lead be placed?
5th ICS, MCL
46
Where should you never put IV’s A-lines when working with Dr. Husain
In the patients dominant hand/arm
47
With Dr. Husain, what do you need to do right away when bringing pt into the room if you gave them versed?
Put o2 on them
48
Coronary Blood Flow and O2 supply and demand
*Apex chart
49
Basics of how the bypass circuit works
Blood drains out through the venous return line > blood reservoir > pump which has the motor > heat exchanger to regulate the temp of the blood > oxygenation which works as the lungs, oxygenating the blood and removing CO2 >oxygenated blood returns to the heart
50
BP management goals for CABG when patient has carotid stenosis
*
51
What is the coronary sinus
Venous drainage system for the coronary arteries *does not drain the entire heart
52
Why is heparin used for cardiac cases rather than Agatraban or Bivalirudin?
They have longer half lives and no reversals
53
Anesthetic management of carotid artery disease
*
54
Coagulation cascasde- explain process What does thrombin do? What does AT3 do?
55
Why dont we have fibrinogen circulating all the time?
I think we do? Did they mean fibrin? Bc fibrinogen is always circulating, it only is activated into fibrin when it needs to form a clot in an acute process *Vascular injury > vasoconstriction > platelet aggregation > platelet plug > thrombin is released converting fibrinogen to fibrin * Fibrin reinforces the platelet plug, finalizing the clot
56
Why do we have conversion steps in the clotting cascade rather than just synthesizing fibrinogen when we need it ?
Protein synthesis is a longer process than enzyme activation & the coat cascade is an acute process that you need to occur quickly when an injury happens ?
57
Is diastole an active or passive process?
Both- Passive and active filling- active requires ATP
58
MOA of Levophed vs Epi vs Neo
Neo- pure alpha 1 vasoconstriction >Gq receptor - phospholipase converts PIP to IP3 and DAG which increases intracellular calcium Epi > -Low doses (2mcg/min) Beta 2 effects - pulmonary and coronary vasodilation - Moderate doses - alpha & beta 1 predominately Levophed> alpha 1 and beta 1 agonism predominately ; the mild beta 1 effects reduce the BRR seen with neo
59
What drugs/things can cause hyperglycemia? (6)
1. Beta-2 agonists 2. Surgical stress 3. Steroids 4. Heparin (impairs glucose uptake into the muscles by inhibiting insulin from binding to the insulin receptor) 5. Hypothermia (increases insulin resistance) 6. Non-pulsatile flow to the pancreas while on pump alters insulin secretion
60
What’s in cryo? (5)
Fibrinogen (factor 1) Factor 8 Factor 13 Fibronectin & VWF
61
How much does 5 pool bag of cryo increase fibrinogen?
By 50mg/dl
62
What does FFP contain Indications?
All the coagulation factors, fibrinogen, and plasma proteins Indications: coagulopathy (elevated PT/PTT, acute warfarin reversal, antithrombin deficiency, massive transfusion protocol, DIC, C1 esterase deficiency (angioedema)
63
Indications for cryo
Low fibrinogen, VWD, and hemophilia

Cardiac (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions