Valves Flashcards
(118 cards)
1
Q
Aortic Stenosis - Valve size?
A
- Normal 3.0
- Severe less than 1.0
-or pressure gradient > 40
2
Q
Aortic Stenosis on pressure volume
A
Up and to the right
3
Q
Causes of aortic stenosis?
A
- Calcification of leaflets
- Rheumatic fever
- Endocarditis
4
Q
Trio of symptoms for aortic stenosis?
A
SAD
1.Syncope - 3 year survival
2.Angina - 5 year
3.Dyspnea - 2 year
5
Q
What disease is acquired with aortic stenosis?
A
Von Willebrand in 90% because molecule is damaged
6
Q
Management of AS?
A
Full Slow and Constricted
-Increase preload
-Decrease HR
-Increase SVR
-Avoid regional
7
Q
Art line waveform in AS?
A
Slow upstroke and delayed peak
Narrow pulse pressure with small amplitude
8
Q
Mitral stenosis size?
A
Normal 5
Severe < 1
Transvalvular > 10
PA pressure > 50
9
Q
Mitral stenosis most common in the world? US?
A
World - rheumatic fever
US - endocarditis
Lupus
10
Q
What other disease can be seen in MS?
A
Afib due to increase in LA pressure
11
Q
P/V loop of mitral stenosis?
A
Down and to the left
12
Q
Management of MS?
A
HR - Slow
Preload - maintain
SVR-maintain
AVOID INCREASE IN PVR
13
Q
Acute Aortic regurg P/V? Causes?
A
-low pressure and volume to the right
-usually caused by endocarditis or aortic root dissection
14
Q
Chronic aortic regurg causes?
A
- Marfan , Ehler Danlos, ankylosing spondylitis
15
Q
Aortic regurg management?
A
Full, Fast, Forward
Preload-maintain or increase
HR-increase
SVR - Decrease
Regional - okay
16
Q
Aortic regurge A-line?
A
Double or biphasic peaks
17
Q
Mital regurg causes?
A
-Ruptured tendineae
-Endocarditis
-Heart disease
-Carcinoid syndrome
18
Q
P/V loop of mitral
regurg?
A
Volume gets sMaller - m for mitral
19
Q
MV regurg management?
A
Full, fast, forward
HR-Increase
Preload- Increase
SVR - decrease
PVR - AVOID increase
20
Q
Aortic stenosis murmur
A
- ASSS
Right of sternal border on systole
21
Q
Aortic regurg murmur
A
-ARDS
Right of sternal border on diastole
22
Q
Mitral stenosis murmur
A
MSDA
Left of apex on diastole
23
Q
Mitral regurgitation murmur
A
MRSA
Left of apex of heart - systolic
24
Q
What three things contribute to RMP?
A
- Chemical force
- Electrostatic counter force
- Sodium/Potassium pump
25
What three ways can HR be manipulated?
1. Spontaneous rate of phase 4 increases
2. Decreased threshold potential
3. Increased RMP
26
DO2?
CO X (Hgb X SaO2 X 1.34) + (PaO2 x 0.003) x 10
27
Normal DO2?
1000 mL/ min
28
Normal O2 extraction?
25% or 250 mL
29
Normal CaO2?
20mL/dL
30
VO2 max?
250 mL /min ( how much O2 is used)
31
Calculate MAP
CO x SVR / 80
+CVP
32
How is blood viscosity calculated?
hematocrit and body temperature
33
Hypothermia and increased hematocrit have what effect on viscosity?
increased
When warming a patient off bypass, a lower Hct can help reduce sheering
34
Pressure inside ventricles and atriums?
LA - 5
LV - 25
RA - 10
RV- ? 120?
35
Thesbian veins?
drain into all chambers
also contributes to cardiac shunt
36
What are the three main cardiac veins? where do they drain?
1. Greater vein - LAD - drains into coronary sinus
2. Middle vein - PDA drains into RA
3. Anterior vein - RCA drains into RA
37
Where do coronary arteries arise from?
Sinus of Valsalva
38
Coronary perfusion pressure?
LVEDP - Aortic diastolic pressure
39
What is the pathway for vasoconstriction of coronary arteries?
Alpha 1 and Histamine 1
Gq pathway
Increased phospholipase C increases IP3, Ca, DAG
40
What is the pathway for vasodilation of coronary arteries?
B2 - Gs > Increase cAMP > decrease in Ca
H2 - Gs > Increase cAMP > decrease in Ca
Muscarinic > increased NO
41
When are the Left coronary arteries perfused?
Diastole
42
When are the right coronary arteries perfused?
Throughout the cycle
43
When do most MI's occur after surgery?
24-48 hours after with a 20% mortality
44
What factors decrease coronary flow?
Tachycardia
Decreased aortic pressure
Decreased vessel diameter
Increased end diastolic pressure
45
What does S3 heart sound mean?
heard after S2 during the beginning of diastole.
flaccid and inelastic heart
46
What does S4 heart sound mean?
Atrial kick
Heard before S1
47
Three conditions that can effect the pericardium?
Acute pericarditis-inflammation
Restrictive pericarditis - fibrosis
Cardiac tamponade
48
What is pulsus paradoxus?
impaired diastolic filing
decreased SPB >10 on inspiration
49
What is Kussmauls sign?
Increased JVD and CVP on inspiration
50
Anesthetic management of pericarditis
CO is HR dependent
Preserve HR and contractility
increased afterload
51
Pressure volume loop of cardiac tamponade?
Down and to left, decreased filling time as well
52
What is Becks triad?
Signs for cardiac tamponade
1. Increased JVD
2. Muffled heart tones
3. Hypotension
Also have decreased ECG amplitude
53
Anesthetic treatment of cardiac tamponade
1. Maintain spontaneous respirations
2. Maintain or increase everything
54
Who does not need antibiotics undergoing cardiac surgery?
CABG
STENT
unoperated valves
GI/GU procedures without infection
55
What is the most common cause of cardiac death among athletes?
HOCUM
56
What is HOCUM?
Left outflow tract obstruction
caused by septum hypertrophy and SAM (systolic anterior motion)
57
Management of HOCUM?
Increase preload
Decrease HR
Decrease Contractility
Increase afterload
58
How to calculate MAP
Diastolic BP + 1/3 Pulse pressure
59
EF classification
>50% normal
41-49% mild
26-40 moderate
<25 severe
60
Primary electrolyte of RMP?
Potassium
61
Does hypokalemia raise or lower RMP?
Makes it more negative
62
Primary electrolyte of TP?
calcium
63
Conditions that increase PVR?
Acidosis
Nitrous oxide
hypothermia
high peep
hypoxia
hypercarbia
64
Guidelines for waiting to have surgery after an MI?
-At least 4 weeks
-< 3 months have a 30% of recurrent
-3-6 months - 15
->6 months - 6%
65
Cardiac risked based procedures.
High risk? cardiac risk > 5%
-emergency surgery
-open aortic
-peripheral vascular surgery
-long procedures
66
how do PDEI work?
inhibit the breakdown of cGMP
67
HTN classification system?
Normal 120/80
Elevated 120-130 / 80
HTN 1 Sys >130-140 or Dia 80-90
HTN 2 Sys> 140 or Dia >90
HTN crisis Sys>180 and or Dia >120
68
What is more common primary or secondary HTN?
Primary. >95%
69
Secondary HTN causes?
Coarctation of the aorta -
1. upper limb BP > lower
2. Weak femoral pulse
3. Systolic bruit
Renvascular disease
1. Bruit
Cushings syndrome
Conn's disease
Pheochromocytoma
Pregnancy - RUQ pain
70
When is the risk of re-stenosis greatest ?
30 days
71
Duration to wait for;
Angioplasty without stent?
Bare Metal?
Drug eluting?
CABG?
2-4 weeks
30 days
6 months for current otherwise 12 months
6 weeks
72
When should anticoagulant therapy be stopped?
Asipirn?
Clopidogrel?
Ticlopidine?
Don't stop aspirin
7 days
14 days
73
Should heparin be used for patients with PCI?
no
74
What is the best treatment for thrombosis?
Stent with blood flow restored within 90 minutes
75
When does the patient experience the most awareness during bypass?
Sternotomy
76
What should ACT be for bypass?
>400 seconds
77
Blood pressure goal for bypass cannulation ?
Sys 90-100 and or MAP <70
78
What is cardioplegia?
Potassium is given which increases the resting membrane potential which locks voltage gated Na+ channels shut
79
How is cardioplegia induced?
Potassium is given antegrade or retrograde.
if given antegrade, aortic valve must be competent and the aorta clamped
80
What blood pressure number do we relay on for organ perfusion?
MAP
81
How many units of protamine to reverse heparin on bypass?
1mg per 100 units of heparin
82
Classes of AAA
Crawford
Type 1 - descending plus upper abdominal
Type 2
- descending plus most of abdominal
Type 3 -lower descending plus most of abdominal
Type 4 - just abdominal
83
Classes of dissecting AAA
Standford
A - ascending
B- not ascending
Debakey
1- tear everywhere
2- tear only in ascending
3 - proximal descending
84
What AAA classifications are emergencies?
Anything of the ascending
Debakey 1 or 2 + Stanford A
85
Hardest AAA to repair?
Crawford type two because of renal arteries
86
What artery can is affected most by a AAA repair?
Artery of Adamkiewicz
87
What happens when an aortic cross clamp is applied? Hypervolemia or hypo?
Hyper by increasing venous return and reducing venous capacity
88
What happens to distal tissues when the aortic cross clamp is applied?
-Switches to anaerobic metabolism which increases to lactic acid and metabolic acidosis
-decreased temp
-Increased prostaglandins
89
What are the benefits to an EVAR?
shorter operative times
shorter length of stay
lower rate of transfusion
reduced morbidity
90
What is the artery of adamkiewicz?
Most important radicular artery that supplies the spinal cord
Thoracic 10
Perfuses anterior spinal cord
91
Strategies to protect the spinal cord?
Moderate hypothermia (31 degrees)
CSF drainage
Nerve monitoring
Avoid hypertension and hyperglycemia
92
Signs and symptoms of anterior spinal syndrome?
flaccid paralysis of lower extremities
Bowel and bladder dysfunction
loss of temp and sensation
****touch and proprioception are preserved
93
How is a AAA seen?
pulsatile abdominal mass
94
What size in cm requires repair of a AAA
>5
95
Signs and symptoms of AAA rupture
back pain
hypotension
pulsatile mass
96
How is cerebral perfusion pressure calculated?
MAP-CVP
97
What is ACT kept above for a carotid ?
>250
98
is an aortic cross clamp required during an EVAR?
no
99
what factors determine myocardial supply?
tachycardia - decrease supply
Increased preload - decrease supply
100
what factors determine myocardial demand?
preload
afterload
contractility
HR
101
how to calculate EF?
SV/EDV
or
EDV-ESV / EDV
102
How to calculate MAP?
1/3 sys + 2/3 dia
103
How can remodeling be reversed?
ACE Inhibitors
Aldactone
104
When is the sub endocardium and endocardium perfused?
Sub = diastole
Endocardium = systole
105
What percent of the CO goes to the coronary's ?
5% or 250mL
106
At rest how much O2 is consumed by the heart? What's the extraction of it?
8-10mL/min//100g
75%
107
What factors decrease coronary flow?
tachycardia
decreased aortic pressure
decreased vessel diameter
increased in end diastolic pressure
108
What factors decrease CaO2?
Anemia
Hypoxemia
109
What factors decrease O2 extraction?
acidosis
decreased capillary density
110
What factors increase O2 demand?
tachycardia
HTN
SNS stimulation
Increased wall tension
Increased afterload
Increased contractility
Increased end diastolic volume
111
NO pathway?
L arginine to NO
No goes to smooth muscle
NO activates guanylate cyclase
Guanylate cyclase to cGMP
cGMP reduces calcium
Phosphodiesterase deactivate cGMP
112
cardiac lab values and timeframes?
1. CK-MB
-3-12 hours
-peaks in 24 hours
-returns in 2 days
2. Trop 1
-3-12hours
-24 hours to peak
-5 to 10 days
3. Trop T
-3-12 hours
-12 to 48 hours to peak
-5 to 14 days to return
113
What is S3 heart sound?
Early part of diastole - right after S2
-Signals CHF or volume overload
114
What is S4 heart sound?
Right before S1
-Signals non compliant ventricle
115
What is the treatment for an MI
Slower, smaller, and better perfused
116
Where do CCB bind to?
Alpha 1 subunit L type calcium
117
What CCB should be used to help with cerebral spasm?
Nimodipine
118
What patients do not need antibiotic prophylaxis against endocarditis?
CABG
unrepaired cardiac valve
Stent placement
