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Quiz 2 Flashcards

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1
Q

Kuassmaul’s sign

A

distention of jugular vein during inspiration (intrathoracic psi increase) present in constrictive pericardiits

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2
Q

pulsus paradoxus

A

pulsus paradoxus when the SBP changes >10mm during inspiration. common in acute tamponade.

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3
Q

dobutamine class

A

a selective beta 1 agonist
causes greater vasodilation of the pulmonary and systemic vasculature. predominantly affects HR compared to SV
ionotropic
used in acute heart failure to increase CO

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4
Q

epi gtt low dose < ___ -___ ng/kg/min for beta effects only

A

at low doses it’s a beta agonist <10-30 nanogram/kg/min . alpha observed after this

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5
Q

isoproterenol is used in what patient population?

A

used primarily in previous cardiac transpolant pts

It is also used in 3rd degree BBB

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6
Q

flecainide is used to treat what condition?

A

effective for treating WPW pts

1C sodium channel blocker

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7
Q

tissues that are Ca2+ dependent

A

pacemaker cells

AV node. affected the most by this class

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8
Q

how to thrombolytics act?

A

they initiate plaminogen’s conversion to plasmin. plasmin causes degradation of thrombin.

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9
Q

what are platelets activated by?

A

von Willebrand factor

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10
Q

desmopressin is a V2 receptor agonist. what does it do?

A

increases vWf and factor VIII.

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11
Q

aminocaproic acid and tranexemic acid are antiplamin agents that…

A

inhibit fibrinolysis by inhibiting plasminogen activation

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12
Q

resistant HTN

A

when PT taking 3-4 antihypertensives of different classes.

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13
Q

refractory HTN

A

when PT taking 5 or moreantihypertensives of different classes. (0.5% of HTN pts…time to r/o 2ndary causes)

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14
Q

10kg of weight loss decreases SBP and DBP by

A

SBP- 6 mmHg

DBP- 4.6 mmHg

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15
Q

epi boluses for hypotension

A

10mcg (double dilution)

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16
Q

LCA divides into the

A

LAD and circumflex arteries

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17
Q

LAD divides into the

A

diagonal branches

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18
Q

circumflex artery gives rise to the

A

obtuse marginal arteries

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19
Q

where is the coronary sinus?

A

it is the venous drainage of the heart and is located at the right atrium bw inferior vena cava and tricuspid valve

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20
Q

unstable angina defn.

A

at rest, new onset, or increasing severity or frequency from previous stable angina

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21
Q

etiology of CAD

A

endothelial damage w cholesterol deposition, LDL formation, and macrophage infiltration

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22
Q

NSTEMI comes from…

A

coronary plaque rupture, vasoconstriction, luminal narrowing, inflammation or excessive O2 demand. Only 50% of NSTEMI patient have significant ECG findings.

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23
Q

___-___ days post MI, when is the tissue very soft, increasing the risk of rupture and aneurysm formation

A

4-7 days

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24
Q

how long does it take to heal after MI to heal and leave behind a fibrous, noncontracting region of thin wall myocardium? ventricular remodeling continues after this time.

A

3 months

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25
coronary artery perfusion psi =
diastolic (aortic) - LVEDP
26
time to wait for elective surgery: angioplasty w/o stenting
2-4 weeks
27
time to wait for elective surgery: bare metal stent placement
at least 30 days
28
time to wait for elective surgery: CABG
at least 6 weeks
29
time to wait for elective surgery: DES stent placement
at least 12 months
30
early stent thrombus occurs
within 24 hours
31
late stent stenosis occurs
30days -1 yr and is usually from malposition or neointimal growth .
32
things beta blockers do
reduce O2 consumption in heart tissue, improve CA blood flow, improve supply/demand ratio, stabilize myocardial membranes, and inhibit platelet aggregation.
33
HAD2SUE | the prebypass checklist
heparin, ACT, Drugs(NMB, amnestic), drips(turned off), Swan pulled back, urine accounted for pre, during and after bypass, and emboli check (deairing the cannula inserted into the patient) . Heparin is given at 300-400 units/kg body weight prior to blood being sent into the circuit. THE PATIENT MUST BE ANTICOAGULATED. Confirm with ACT 3-5 minutes after anticoagulation. ACT must be >400 (or 450).
34
what should SBP be before cannulation
90-100 or MAP< 70....or else aorta dissects.
35
CPB flow is __-___ ml/kg/min with a psi of __-__ mmHg.
50-60 mL/kg/min | 50-70mm Hg
36
coming off pump....Wide Receive Most Valuable Player(mneumonic)
``` Warm: is the patient and heart warm? Rhythm-NSR or do we need to pace? Monitors-turn them back on Ventilation-turn on the ventilator Perfusion-what is the pump flow? ```
37
cardioplegia can be given antegrade through_______ or retrograde through_________
cardioplegia can be given antegrade through the coronary arteries or retrograde through_ the coronary sinus and cardiac veins
38
type I brain injury outcomes in cardiac surgery
death, stroke, coma, and TIA
39
type 2 brain injury outcomes in cardiac surgery
cognitive deterioration
40
what is sandblasting?
when the cannulae punctures the aorta where a large arthroma exists, emboli are created a
41
how are stenotic valves treated medically?
by suppressing heart rate to prolong diastole
42
how are regurgitant valves treated?
by reducing afterload to reduce the regurgitant fraction.
43
bioprosthetic valves are
porcine, bovine hererografts or human homografts
44
how long do mechanical valves last?
20-30 years but form clots and therefore require lifelong anticoagulation.
45
bioprosthetic valves last how long?
tissue valves last 10-15 years and do not require anticoagulation and as such are typically reserved for the elderly.
46
what valve disorder is from rheumatic heart fever?
mitral stenosis...it is very rare and more common in developing countries. F>M. takes 20-30 yrs for the process to become symptomatic following rheumatic fever
47
what increases PVR?
N2O hypercarbia hypoxemia trendelenberg position
48
what is the most common cause of mitral regurg?
IHD structural if the issue is from the leaflets or chordae functional if coming from VL stretching
49
volumes of ____ or more are severe MR
60% | survival is better if surgery is undertaken when EF is >60%
50
the goals of anesthesia in patients with MVR
``` FAST, FULL, FORWARD!!!!!!!!! prevent bradycardia prevent increases in SVR minimize cardiac depression monitor the regurgitant volume. ```
51
what is mitral valve prolapse?
it is when 1 or both of the mitral leaflets prolapse into the LA during LV systole. it is a midsystolic click and late systolic murmur. and the most common valvular disorder
52
What is a normal ACT?
80-120 seconds
53
the CPB circuit can absorb up to 90% of what drug circulating during bypass?
NTG
54
RBCs are concentrated into a cellsaver bag | (platelets and coagulation factors are removed) with a HCT of ___-___%
55-70%!
55
If MR is present, what MAC is associated with reductions in regurg fractions
0.5 MAC
56
Classic critical AS symptoms are.....
angina, syncope, DOE, and CHF symptoms with a less than 5 yr life expectancy
57
normal AV area is 2.5-3.5cm2. What is critical?
Critical AS is | either 0.8 or 0.7cm2
58
goals during aortic regurg/
fast, full, forward (hint: all regurges are this!!!!!) Goal HR>80 fluid status at normal volumes
59
TS is extremely rare and caused by...
RHD or carcinoid syndrome.
60
Early afterdepolairzations (EAD) more commonly occur in where?
in Purkingje fibers. They are | enhanced by slow heart rate and are treated by speeding up the heart rate.
61
what is a Stokes-Adams attack?
3rd degree AVB causes it. CHF, SOB, bradycardia. Isoproterenol to treat, pacers to definitively treat
62
bainbridge reflex
when the intrathoracic psi increases, so does the HR with inspriation. Opposite, the heart rate slos as intrathoracic psi lowers.
63
paroxysmal supraventricular tachycardia is a HR of 160-220 that begins and ends spontaneously. What is orthodromic and what is antidromic?
orthodromic if QRS is narrow.(more common) | antidromic if QRS is wide.
64
asynchronous pacing is the simplest form of pacing. Modes are....
AOO, VOO, DOO, (meaning atria are paced with no sensing and not response, since there is no sensing)
65
What are the pacing positions for I, II, III
pacing chamber, sensing chamber, response to sensing.
66
Dressler syndrome
1-2 days post MI. thought to be an autoimmune response.
67
pericardial effusion defn
more fluid is in the pericardial sac than normal
68
pericardial tamponade defn
that fluid is under psi.
69
Beck's triad
muffled/distant heart sounds increasing JVD hypotension
70
what is levosimendan
a calcium sensitizer, enhances endogenous calcium to increase contractility. no increase in O2 consumption. some dilation of systemic pulmonary and CA arteries.
71
Nesiritide is a BNP analogue that works at the ...
A and B-type receptors. inhibits RAAS, causes vasodilation and promotes diuresis. acts similarly to NGT w/o prounounced hypotension effects.
72
IABP...when does the balloon inflate?
during diastole(as the R wave occurs, creating a vacuum effect that reduces afterload and enhances ventricular ejection.)
73
which ECMO type is for respiratory pts?
venovenous
74
how long from donor to recepient for a heart?
4 hours.
75
what drugs are ineffective in a transplanted heart?
ephedrine, anticholinergic drugs or cholinesterase drugs. Vasopressin may be needed to treat hypotension.
76
agents that lower PVR
NO, isoproteronol, prostaglandins, of PDEI

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