Test 1 Flashcards
1
Q
Aortic annulus is attracted to pulmonic annulus by
A
Tendon of conus
2
Q
Aortic annulus also connected to AV valves by
A
Ventral fibrous body
3
Q
What constitutes the fibrous cardiac skeleton
A
Four valve annuli
4
Q
4 components of skeletal base of heart
A
Valve annuli
Aortic and pulmonary roots
Central fibrous body
Fibrous trigones
5
Q
Location of coronary sinus
A
Between AV orifice and valve of IVC
6
Q
Compare thickness of RV and LV
A
RV 4-5mm
LV 8-15mm
7
Q
Compare upper 1/3 of septum to lower 2/3
A
Upper 1/3 is smooth endocardium
Lower 2/3 is trabeculae
8
Q
Myocardium is ____ layers. Middle is _____
A
3
Middle is muscular which runs in spiral fashion
9
Q
Normal size of aortic, tricuspid, and mitral valve
A
Aortic. 2.5-3.5 cm2
Mitral. 4-6 cm2
Tricuspid. 7 cm2
10
Q
Coronary artery which typically provides flow to bundle branches
A
LAD
11
Q
Provides flow to anterior 2/3 of IVS, bundle branches, papillary muscles of MV, anterior-lateral and apical LV
A
LAD
12
Q
Provides flor to LA and posterior-lateral LV
A
Circumflex
13
Q
Provides flow to SA/AV nodes
A
RCA
14
Q
Provides flow to SA/AV nodes, RA, RV, posterior 1/3 of IVS
A
RCA
15
Q
Dominance is determined by
A
Whether the circumflex of RCA provides flow to PDA
16
Q
Effect of CAD of coronary vascular smooth muscle tone and anitcoagluation
A
Thickening of endothelium resulting in clot- vasospasm
Adversely effects autoregulatory fx of vascular endothelial cells expressing anticoagulant substances and myocardial blood flow
17
Q
Define coronary perfusion pressure and its component/formula
A
CPP = DBP - LVEDP
18
Q
Compare LV and RV perfusion in systole and diastole
A
RV fills throughout cycle
LV fills during diastole
19
Q
Area of myocardium most affected by extravascular compression and higher LVEDP
A
Subendocardium
Lower heart rate minimizes compression
20
Q
Key responses to CAD in coronary circulation
A
Collateral flow and remodeling
21
Q
4 determinants of coronary blood flow
A
Perfusion pressure
Myocardial extravascular compression
Myocardial Metabolism
Neurohumoral control
22
Q
Determinants of myocardial oxygen supply
A
Heart rate ** PCWP/LVEDP** DBP O2 sat Hct CAD
23
Q
Components of myocardial oxygen demand
A
Heart rate **
PCWP/LVEDP **
SBP
CO
24
Q
2 determinants of myocardial oxygen balance that both decrease supply and increase demand
A
Increased HR and PCWP/LVEDP
25
Increased SNS from what segments increase chronotropy and inotrope
T1-T4
26
Effect of increased PNS activation on chronotropy
SNS competes with PNS in medulla
PNS has only modest effect on inotropy 30%
27
Role of accessory pathways in dysrhythmia
Abnormal accessory pathways bw atria and ventricles may bypass the AV node and cause re-entrant dysrhythmias
28
Basic contractile unit of monocytes
Sarcomere
29
Effect of actin-myosin configuration on contractility based on frank starling law
If hypovolemia don’t have same wall tension and suboptimal interaction
30
Wall stress is typically greatest where
Subendocardium
Blood supply lowest and demand highest
31
normal size of aortic valve
>2cm
2.5-3.5cm2
32
Normal mitral valve area
>2cm
33
role of accessory pathways in dysrhythmias
Bypass AV node causing re-entrant dysrhythmias
34
LaPlace’s law. ______ and ______ vary directly with _________. Inversely with _____
Wall stress and MVO2 diaries directly with internal pressure.
Inversely with wall thickness
35
Wall stress is typically greatest in ______
Why
Subendocardium
Blood supply lowest due to LVEDP
Demand highest
36
Myocardial sarcomere are relatively permeable to _______ and impermeable to_____
Permeable to K+
Impermeable to Na and Ca
37
Phase 0 ion movment
Fast Na channels open
Then slow Ca channels
38
Phase 1 ion movement
K+ channels open
39
Phase 2 ion movement
Ca channels more open
40
Phase 3 ion movment
K+ channels open more
41
Phase 4 ion movement
RMP
42
SA node AP has no phase _____
1 and 2
43
Pint 1 on pressure volume loop
MV closes
44
Point 2 on pressure volume loop
AV valve opens
45
Point 3 on pressure volume loop
AV closes
46
Point 4 on pressure volume loop
MV opens
47
Increased preload effect on pressure volume loop
Shifts to right
Increased SV
48
EDPVR is directly related to
LV compliance
49
Effect of increased afterload on pressure volume loop
Narrow and taller
Lower SV and higher pressures
Higher EDV
ESPVR reduced
50
ESPVR related to
Myocardial contractility
51
ESPVR is heart rate sensitive index of
Contractility
52
Heart failure shifts LV volume loop
To right
Compensates for decreased contractility
53
Aortic stenosis effect on PV loop
Higher pressure for given volume
Taller
54
Diastolic heart failure PV loop changes
Flat frank starling curve
55
Ways body compensates for heart failure
Salt and water retention
Vasoconstriction
Sympathetic stimulation
56
CV effects of valsalva maneuver
Decreased HR, contractility, vasodilation
57
CV effects of baroreceptors reflex
Decreased HR, contractility, vasodilation
58
CV effects of Oculocardiac reflex
Bradycardia
asystole
dysrhythmia
hypotension
59
CV effects of celiac reflex
Bradycardia
Hypotension
Apnea
60
CV effects of Bainbridge reflex
Increased HR
Decreased BP
Decreased SVR
Diuretics
61
CV effects Cushing reflex
SNS = hypertension
62
CV effects Chemoreceptors reflex
Increased respiratory drive
Increased BP
63
Determinants of BP
Cardiac Output
- HR
- SV
SVR
64
CO components
HR
SV
65
Components of SVR
Tone X Viscosity
66
Effect of alpha 1 receptors
Vasoconstriction
67
Effect of alpha 2 receptors
Blocks output- vasodilation
68
Effect of beta1 receptors
Increase heart rate and contractility
69
Effect of beta 2 receptors
Vasodilates
Increases glyco neo genesis
70
Effect of Muscarinic receptors
Decrease heart rate
Activates salivary/sweat glands
Limited decreased vascular tone
71
Epinephrine activates which receptors
Alpha and beta
72
NE activates
Alpha 1, alpha 2, and beta 1 receptors
NO beta 2
73
Dopamine activates which receptors
Alpha 1, beta 1, and dopamine receptors
NO alpha 2 or beta 2
74
Only catecholamines that activates beta 2
Epi
75
Preganglionic release which NTS sympathetic pathway
Acetylcholine.
76
Postganglionic sympathetic fibers release
NE
77
Termination of NE due to
Reuptake, dilution by diffusion or metabolism by MAO
78
Dexmedetomidine receptor and hemodynamic effects
Alpha 2 agonist
79
Receptor for carvedilol and hemodynamic effects
Mixed alpha beta antagonist
80
Receptor and hemodynamic effects of NE
Nonselective alpha beta
81
Receptor and hemodynamic effects epi
Non selective alpha beta
More beta 1
82
Receptor and hemodynamics for labetalol
Mixed alpha beta antagonist
83
Esmolol receptor and hemodynamic effects
Beta 1 antagonist
84
Four mechanisms of adrenergic receptor activation
Binding
Promote NE release
Block NE reuptake
Inhibition of NE inactivation
85
Ex of catecholamines
Epi
NE
Isoproterenol
Dopamine
Dobutamine
86
Examples of non- catecholamines adrenergic agonists
Ephedrine-alpha and beta
Phenylephrine- alpha 1
Terbutaline- beta 2
87
Clinical uses of alpha 1 activation
Nasal decongestant
Hemostasis
Adjunct to LA
Mydriasis
Elevation of BP (neo, NE)
88
Adverse effects of alpha 1 activation
Hypertension
Necrosis (extravasation of IV)
Bradycardia
89
CV effects of beta 1 activation
Increased HR, contractility, automaticity, conduction through AV node
Renin release from JG cells
90
4 therapeutic applications of beta 1 activation
Initiate contraction in arrest
Increase contractility in failing heart
Increase CO in shock
Improve AV conduction when AVB present
91
Adverse effects of beta 1 activation
Tachycardia
Dysrhythmias
Increased MVO2 = angina
92
Beta 2 receptor activation
Bronchodilation
Tocolysis on uterus
93
Overall CV effects of PDE-3 inhibitors
Vasodilation
Increased organ perfusion
Decreased SVR
Decreased BP
Increased contractility, HR, SV, EF
Decreased preload and PCWP
94
Dopamine 1-5mcg/kg/min
Induces natures is
Binds with D1 receptor dilating renal and mesenteric blood vessels
95
Dopamine at 5-10 mcg/kg/min
Primarily beta1 with increase in contractility and HR
96
Dopamine at >10mcg/kg/min
Primarily alpha1
97
Uses of vasopressin
Potent vasoconstriction
Volume loss in DM
Bleeding esophageal varicose
Vasoplegia with CPB
98
Most anesthetics and surgical stimulation
Alter ANS, autonomic reflexes, vasomotor control by pons/medulla
99
Increased density or receptors
Up regulation
Chronic decrease in receptor stimulation
100
Decreased density of regulation
Down regulation
Result of chronic increase in receptor stimulation
101
Factors influencing hemodynamic response to induction agents
```
Premedication
Dose
Speed of administration
CV disease and compensation
EF
Emotional state
Baseline autonomic tone
Home meds
Influence of adjuvant drugs
Age
DM
HTN
```
102
Variables affecting anesthesia induction drug dose selection
```
Weight
Adjuvant anesthetics
Elderly
Trauma
Poor heart function
Timing
```
103
Hemodynamic effects of propofol
Decrease in BP ***
| Decrease preload, contractility, afterload (CO, SV)
104
Vasodilator effect of propofol due to
Decrease in sympathetic outflow
Direct vasodilation
105
Hemodynamic effects of thiopental
Increase HR
Decrease CI, BP, LVEDP
Histamine release
Decrease sympathetic outflow
Decrease contractility
106
Hemodynamic effects of methohexital
Increase in HR
Decrease in BP, profound hypotension
Decreased sympathetic outflow
107
Hemodynamic effects of diazepam
Decreased BP but slow onset and easier to control
Decree in MVO2 and LVEDP
HR decrease w/ sleep
Combine with opiate = profound decrease in SVR
108
hemodynamic effects of midazolam
Decrease in BP (more than Valium)
Mild increase in HR (5-15%)
109
Hemodynamic effects of Etomidate
DRUG THAT CHANGES HEMODYNAMIC VARIABLES THE LEAST
Very useful with hypovolemic
110
Hemodynamic effects of Ketamine
Increase MVO2
| Increase PVR and SVR
111
Benefits of using N2O
Hasten onset
Short duration
Decrease dosage of other volatiles
112
Indications for inhaled induction
Compromised airway
Children
Indwelling ETT, trach
Needle phobia
113
Dosage for cardiac anesthesia
Propofol
0.2-1.5mg/GI
114
Dosage for cardiac anesthesia
Thiopental
0.5-4mg/kg
115
Dosage for cardiac anesthesia
Etomidate
0.1-0.3mg/kg
116
Dosage for cardiac anesthesia
Fentanyl
3-25mcg/kg
117
Dosage for cardiac anesthesia
Sufentanil
0.5-2mcg/kg
118
Dosage for cardiac anesthesia
Remifentanil
0.1-0.75mcg/kg/min
119
Dosage for cardiac anesthesia
Cisatricurium
70-100mcg/kg
120
Dosage for cardiac anesthesia
Vecuronium
70-100 mcg/kg
121
Dosage for cardiac anesthesia
Pancuronium
70-100 mcg/kg
122
Dosage for cardiac anesthesia
Succinylcholine
1-2mg/kg
123
Effects associated with intubation after induction with etomidate
Increase HR 15%
CI 19%
SVR 4%
124
Effects associated with intubation after induction with propofol
Increase HR 15%
SV 9%
CI 18%
125
Effects associated with intubation after induction with midazolam
Increase HR 4%
SVR 5%
CI 9%
126
Primary mechanism responsible for the CV effects of volatile anesthetics
Reduce intracellular calcium concentration
Reduce influx through sarcolemma and release from SR
127
Relationship between dose of volatiles and BP
decrease in dose related fashion
Due to decreased SVR
128
Relationship between dose of volatiles and SVR
Decrease in dose dependent fashion
Iso most
129
Relationship between dose of volatiles and CI
Decreases due to vasodilation and preload reduction
HR increases and compensatory so CI sustained
130
Relationship between dose of volatiles and HR
Increased due to modulation of SA automaticity, modulation of baroreceptors reflex, SNS activation
Des most
131
Effect of N20 on MACBAR of sevo
2.2MAC
132
Effect of N20 on MACBAR of des
1.3 MAC
133
Addiction of 1.5-3mcg/kg fentanyl decreases MACBAR to
0.4MAC
