PVD, Pericardial, HF

Question 1

Causes of pericardial inflammation

Answer 1

Infection (viral, bacterial, fungal, TB), MI (dressler’s syndrome), trauma/cardiology, metastatic disease, drugs, mediastinal radiation, systemic disease, RA, SLE, scleroderma

Question 2

Acute pericarditis dx

Answer 2

Onset severe CP w insp especially. Diffuse ST seg elev, PR seg dec, T wave inversion. Pericardial friction rub

Question 3

Tx acute pericarditis

In absence of what doesnt alter function

Answer 3

Salicylate/NSAIDS, analgesics, steroids.

Effusion

Question 4

Most effective method to detect effusion

Answer 4

Echo- presence and size

Question 5

Cardiac tamponade: exists when what. Filling related to what

Answer 5

Inc in pericardial pressure impairs diastolic filling. Filling r/t diastolic transmural pressure across each chamber

Question 6

In tamponade what reduces filling

Answer 6

Any increase in pericardial pressure r/t pressure within chamber

Question 7

S/s tamponade

Answer 7

Inc CVP, pulsus paradoxus, equalization of cv filling pressures, low BP/CO/SV/ecg voltage, SNS activ, tachypnea, Jvd, muffled heart sounds

Question 8

Tamponade tx

Answer 8

Pericardiocentesis, subxiphoid pericardiostomy, thoracic pericardiostomy (open or thoroscopic)

Question 9

Tamponade- anesthesia management

Answer 9

Volume, inc contractility, correct metabolic acidosis. Local or ketamine

Question 10

What causes constrictive pericarditis

Answer 10

Idiopathic, previous cv surgery, exposure to radiotherapy, TB

Question 11

Constrictive pericarditis s/s

Answer 11

CVP, RAP, PCWP high, CO low, tired, atrial dysrhythmias, edema, ascites, hepatomegaly, pulsus paradoxus, JVD

Question 12

Constrictive pericarditis tx

Answer 12

Surgical stripping and removal of pericardium

Question 13

Constrictive pericarditis anesthesia management

Answer 13

Minimize changes to HR/SVR/preload/contractility (ketamine, etomidate, panc). Avoid Brady. Maintain volume to avoid low BP (IV and a line). Blood transfusions, a lot of intraop blood loss.

Question 14

PVD: ABI less than what

Answer 14

0.9. Ration SBP to DBP in ankle vs brachial artery

Question 15

What causes PVD

Answer 15

Atherosclerosis most often, arterial embolism, vasculitis

Question 16

Atherosclerosis RF: 9

Answer 16

DM, age, male, obese/sedentary, essential htn, smoking, dyslipidemia, family hx

Question 17

Atherosclerosis: most common symptom

Answer 17

Intermittent claudication, angina of legs. Pain starts w exercise and stops w rest

Question 18

Atherosclerosis: most severe symptom

Answer 18

Critical limb ischemia. Rest pain. Lack of 02 at rest, assoc w non healing ulcers and gangrene

Question 19

Atherosclerosis: ABI normal, claudication, rest pain, ischemic ulcer or impending gangrene

Answer 19

.95.

Question 20

Atherosclerosis: overall dx tests

Answer 20

Doppler, aBI, ultrasound duplex, transcutaneous oximetry, MRI, contract angio

Question 21

Atherosclerosis: transcutaneous oximetry normal vs abn

Answer 21

Normal 60 mmHg, <40 in pt w skin ischemia

Question 22

Peripheral revascularization surgery steps

Answer 22

Arteries exposed, tunnel created, graft passed. IV heparin given, anastomoses made, arteriogram to confirm flow. Heparin likely not reversed

Question 23

PVD anesthesia: risk

Answer 23

Atherosclerosis, esp in ischemic HD. PVD 3-5x greater risk MI/stroke/death.

Question 24

Anesthesia PVD: which skill most important

Answer 24

Monitoring hemodynamics and responding quickly more imp than specific agent used

Question 25

Peripheral revasc: pts commonly have what. Anesthesia consid

Answer 25

CAD, DM, HTN. Pts take BB/meds preop, A line, CVP/CO/foley, estimated BL, estimated 3rd space

Question 26

Benefits of regional in PV procedures

Answer 26

Inc graft blood flow, less inc SVR w cross clamp, postop pain relief, less activ of coag system

Question 27

PVD surg: assess for, which regional may be best, no diff in what, sig diff in what

Answer 27

Coagulopathy. Spinal- avoid hematoma. No diff in RA vs GA for cardiopulm complic, big diff in graft occlusion rate

Question 28

Anesthesia management PVD

Answer 28

Co-morbidities (CAD, htn), med hx impact on anesthesia, end organ perfusion/02 maintain, blood gas (lyte, ph), cross clamp- time, heparin admin, reversal

Question 29

Adaptive responses to heart failure

Answer 29

SNS, alt hr/afterload, humoral mediated. When they become maladaptive leads to remodeling

Question 30

In HF SNS response: arteriolar constriction does what, venous constriction does what

Answer 30

Arteriolar- maintains BP despite CO decrease. Redirects BF to coronaries and cerebral. Venous- inc preload

Question 31

HF adaptive responses that increase CO

Answer 31

Inc contraction velocity, reduce afterload, increase HR

Question 32

IN HF what release of ANP and BNP do

Answer 32

Promote BP control/protect from vol and pressure overload. Diuresis, natiuresis, vasodilation, anti inflammatory, inhibit RAS/SNS/remodeling

Question 33

HF meds/devices: 11

Answer 33

ACEi/Ang II blockers, aldosterone antag, diuretics, dig, inotropes, BB, vasodilator, biventricular pacing, natrecor, assist devices

Question 34

Anesthesia management HF 4 main

Answer 34

Overall prevent and avoid myocardial depression. HR- normal- elev. preload- normal-high. Afterload- low. Increase contractility

Question 35

HF anesthesia: hypotension tx w 3, GA doses may be ___, do what to decrease pulm congestion

Answer 35

Ephedrine, phenylephrine, vaso. Decreased. PPV.

Question 36

HF anesthesia: regional ___, avoid __ __

Answer 36

Ok, fluid overload

Question 37

Hypertrophic CM: __ __ __ obstruction from __ __ hypertrophy. __ dysfunction. __ ischemia and __

Answer 37

LV outflow tract, asymmetric septal. Diastolic. Myocardial, dysrhythmias

Question 38

Things that increase outflow obstruction in hypertrophic CM: 10

Answer 38

Inc contractility, B adrenergic stim, dig, dec preload, low volume, dilators, tachycardia, PPV, dec afterload, hypotension

Question 39

What decreases outflow obstruction in hypertrophic cardiomyopathy: 10

Answer 39

Dec contractility, b adrenergic blockage, VA, CCB, inc preload/volume overload, bradycardia, inc afterload, hypertension, a adrenergic stim

Question 40

Anesthesia management hypertrophic cardiomyopathy:

Answer 40

Mild contractility depression, VA good, tx hypotension w phenylephrine and volume. NO Bb. Prompt replacement of blood/fluid. Avoid dilators and maintain NSR.

Question 41

Dilated CM: anesthesia goals

Answer 41

Prevent myocardial depression. HR norm to high. Preload norm to high. Low afterload. Increase contractility

Question 42

Cor pulmonale: caused ny what

Answer 42

RV enlarge w/hypertrophy +/- dilation leading to RHF. Caused by pulm htn and chronic alveolar hypoxia

Question 43

Cor pulmonale management

Answer 43

Elim infection, reverse bronchospasm, improve expectoration, maintain good 02/hydration/lung mechanics, correct lyte imbalance

Question 44

Cor pulmonale: biggest thing to maintain. Avoid what 2 things. Give what preop

Answer 44

Oxygenation. Histamine releasors and high level block w regional. Give bronchodilators