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SEE Prep > Valley Cardiac > Flashcards

Valley Cardiac Flashcards

(72 cards)

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1
Q

What causes S1? S2?

A

S1 closure of the AV valves
S2 closure of the Aortic and Pulmonic valves

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2
Q

An S3 is an indicator of what condition?

A

congestive heart failure

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3
Q

What percentage of Ao Regurg is considered mild/mod/severe?

A

Mild < 20
Mod 20-40
Severe 40-60

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4
Q

What is the classic PDA murmur?

A

Mechanical continuous murmur, peaking at S2

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5
Q

What percentage of EF is provided by atrial kick?

A

30%

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6
Q

What is the normal range for SV index?

A

40-60 ml/beat/m2

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7
Q

What percentage of CO goes to the liver?

A

25%

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8
Q

What percentage of CO goes to the lungs?

A

100% (duh)

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9
Q

What percentage of CO goes to the kidneys?

A

20%

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10
Q

What percentage of CO goes to the brain?

A

15%

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11
Q

Where does bronchial circulation arise?

A

From the LEFT (off the thoracic aorta and intercostal arteries)

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12
Q

What is the normal pressures in the following:
RA, RV, LA, LV

A

RA 1-8
RV 15-30/0-8
LA 2-12
LV 100-140/0-12

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13
Q

How do you estimate MAP?

A

1-2-3 rule
(1 x SBP + 2xDBP)/3

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14
Q

What are the two determinants of arterial blood pressure? Which law does this represent?

A

CO and SVR
Ohm’s Law

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15
Q

What is the calculation for SVR?

A

[(MAP-CVP)/CO] x 80

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16
Q

What maintains systemic arterial blood pressure during diastole?

A

The elastic recoil of arterial blood vessels

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17
Q

What are the two determinants of pulse pressure?

A

SV and arterial compliance

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18
Q

Pulse pressure decreases when:

A

either cardiac output decreases or arterial compliance increases

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19
Q

Pulse pressure increases when:

A

cardiac output increases or arterial compliance decreases

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20
Q

When arterial vessels are less compliant, does pulse pressure increase or decrease?

A

It increases. This is why old people have super low diastolic pressure

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21
Q

Where are venous baroreceptors located?

A

Right atrium and great veins

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22
Q

What is the Bainbridge Reflex?

A

An increase in vascular volume causes an increase in heart rate

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23
Q

Where are arterial baroreceptors located?

A

Carotid sinus and aortic arch

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24
Q

Will pulse pressure be increased or decreased in a pedal pulse?

A

It will be increased. The more peripheral you get the higher the systolic and the lower the diastolic

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25
What is the colloidal osmotic pressure of albumin?
22mmHg
26
What percentage of CO goes to the VRG?
75%
27
What are the determinants of blood flow to an organ?
Pressure gradient and resistance Ohm's Law
28
Blood flow to an organ is most directly related to _______
the organ's metabolism metabolites result in vasodilation, which increases perfusion
29
Fully saturated hemoglobin carries _______ molecules and _______ atoms of oxygen
4 molecules 8 atoms
30
How does hypercapnia impact cerebral vasculature? Systemic Vasculature?
Causes vasodilation in both cerebral and systemic vasculature
31
How does hypercarbia impact pulmonary vasculature?
Causes vasoconstriction
32
How does acidosis impact PVR and SVR?
Increases PVR Decreases SVR
33
Describe systolic coronary artery flow in the right and left arteries
On the left side of the heart, flow ceases during systole on the right, flow continues during systole
34
What is the resting coronary blood flow in ml/min?
225-250 ml/min
35
What is the resting coronary blood flow in ml/min?
225-250 ml/min
36
What is the O2 extraction rate in cardiac muscle?
70%
37
How is coronary perfusion pressure calculated?
The Aortic diastolic pressure - LVEDP
38
What is the most potent vasodilator released by cardiac cells?
Adenosine
39
What is the O2 consumption rate of the heart?
8-10 ml/100g/min
40
What determinant of cardiac output most determines oxygen consumption?
Heart rate. Tachycardia will increase myocardial oxygen demand more than preload or afterload. This means increasing preload is the LEAST costly way of increasing cardiac ouput
41
Where in the coronary vasculature are alpha 1 receptors found?
In the endocardium, where they vasoconstrict
42
Where in the coronary vasculature are beta 2 receptors found?
In the subendocardium and intramuscular, where they vasodilate
43
What layer of cardiac muscle is most susceptible to ischemia?
the subendocardium, because it has the greatest metabolic demands and is most compressed during systole
44
What is myocardial preconditioning?
Anytime you have a brief ischemic period, the heart adapts so that subsequent more severe periods of ischemia are less detrimental
45
Which anesthetic agents can trigger or modulate the myocardial conditioning response?
All of the volatile anesthetics mimic ischemic preconditioning. Adenosine or opioid agonists may also.
46
Which anesthetic agent antagonizes cardiac preconditioning?
Ketamine
47
What is phase 0 of cardiac conduction
48
What is phase 1 of cardiac conduction
49
What is Phase 2 of cardiac conduction
50
What is Phase 3 of cardiac conduction
51
What is Phase 3 of cardiac conduction
52
What does the SNS innervate in the heart?
atria, ventricles, and conduction system
53
What does the PNS innervate in the heart?
SA, AV, and atria
54
Does acute hypokalemia increase or decrease cardiac excitability?
Decreases If there's less potassium outside the cell, the gradient is even higher, causing hyperpolarization
55
What are the characteristics of sick sinus syndrome?
bradycardia punctuated by episodes of SVT, usually in the elderly patient
56
What is the most common pre-excitation syndrome?
WPW
57
What is the difference between eccentric and concentric hypertrophy?
With concentric, the volume of the ventricle remains the same. With eccentric, the volume increases from dilation
58
What causes concentric hypertrophy?
Increased afterload
59
What causes eccentric hypertrophy?
Increased preload
60
Diastolic dysfunction means there is a decrease in ventricular _________
Compliance
61
Systolic dysfunction means there is a decrease in ventricular _______
Contractility
62
Which valvular abnormality is associated with a systolic and diastolic murmur?
Aortic Stenosis
63
What are the five hemodynamic goals of aortic stenosis management?
Slow (50-70 bpm) Full (maintain preload) Tight (Maintain afterload) Regular (Maintain SR) Not too strong (maintain contractility)
64
Why is afterload maintenance so important in the patient with aortic stenosis?
Afterload is fixed by the stenotic valve, and any decrease in arterial afterload can worsen coronary perfusion pressure
65
What are the hemodynamic goals for mitral regurgitation?
Maintain preload Decrease afterload increase heart rate maintain SR avoid increasing PVR
66
What are the hemodynamic goals in HOCM?
Increase Preload Increase afterload Maintain SR Slightly depress contractility
67
What four changes will cause LVOT obstruction in HOCM patients?
A decrease in preload A decrease in afterload An increase in contractility An increase in HR
68
What is the first line treatment for hypotension in the patient with HOCM?
Fluid! increase preload!
69
Which vasopressor would you use in a HOCM patient?
an alpha agonist. don't want any beta agonism
70
What is the probability a patient will have their first MI in the perioperative period?
less than 10%
71
What is Beck's triad?
The pericardial tamponade trio: hypotension muffled heart sounds JVD
72
What are the first signs of tamponade?
hypotension with reflex tachycardia

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