Week 1 (Exam 1) Flashcards
(108 cards)
1
Q
SV equation:
A
EDV-ESV
2
Q
Normal SV:
A
60-100ml
3
Q
CO equation and normal amount:
A
SVxHR
3-9L/min
4
Q
Increased LVEDP may be caused by:
A
Aortic stenosis
5
Q
Pressure of blood in thoracic vena cava, near the right atrium:
A
Central venous pressure
6
Q
8 factors that increase CVP:
A
- Hypervolemia
- Forced exhalation
- Tension pneumothorax
- HF
- Pleural effusion
- Decreased CO
- Cardiac tamponade
- Mechanical ventilation with PEEP
7
Q
3 factors that decrease CVP:
A
- Hypovolemia
- Deep inhalation
- Distributive shock
8
Q
Indirect measure of left atrial pressure:
A
Pulmonary capillary wedge pressure
9
Q
Normal PCWP:
A
6-12mmHg
10
Q
3 gold standard determining causes from PCWP:
A
- Acute pulmonary edema
- LV failure and mitral stenosis
- Failure of LV output
11
Q
What is pulmonary edema with normal PCWP:
A
ARDS or non-cardiogenic pulmonary edema (opiate poisoning)
12
Q
Vasodynamic parameter relating CO to body surface area (BSA)
A
Cardiac Index (CI)
13
Q
Normal CI:
A
2.1-4.9 L/min/m2
14
Q
PaO2 equation:
A
102-(age x .3)
15
Q
Performance of cardiac muscle:
-frank starling’s law
A
Contractility
16
Q
Force or enters of muscular contractions
A
Inotropic
17
Q
Changes the HR
A
Chronotropic
18
Q
Coronary blood flow inadequate to meet the demands of the myocardium:
A
Ischemic heart disease
19
Q
6 things that decrease supply to heart:
A
- Tachycardia
- Decreased O2 content
- Anemia
- Arterial hypoxemia
- Hypocapnia
- Hypotension
20
Q
3 things that increase demand to heart:
A
- Sympathetic nervous system (tachycardia and HTN)
- Increased myocardial contractility
- Increased preload and afterload
21
Q
CorPP equation:
A
Arterial diastolic pressure - LVEDP
22
Q
CPP of at least what is thought to be necessary for return of spontaneous circulation (ROSC):
A
15mmHg
23
Q
Coronary filling during systole?
A
NO
24
Q
Coronary filling during diastole?
A
Yes
25
Point where QRS ends and ST segment begins:
J-point
26
Is j-point more horizontal or vertical?
More horizontal
27
ST segment elevation with upward convexity:
Benign, especially in healthy, asymptomatic individuals
28
ST segment elevation with downward concavity:
Due to acute coronary syndrome
29
Leads that have inferior view of heart:
II, III, aVF
30
Leads that have lateral view of heart:
I, aVL, V5, V6
31
Leads that have anterior view of heart:
V3, V4
32
Leads that have septal view of heart:
V1, V2
33
4 EKG criteria for ischemia:
1. 2mm depression, 8ms after J point in up slope ST segment
2. 1mm depression, 60-80ms after J point in horizontal ST segment
3. ST segment elevation
4. T wave inversion
34
Which lead is more important tool for LV ischemia:
V5
35
Which lead is most important for RCA ischemia:
Lead II
36
Cardiac marker used to assist diagnoses of an acute myocardial infarction:
Troponin
37
BP increase because SVR increased
| Work of heart and O2 demand increased because of increase in afterload
Increased ABP
38
3 treatment options for increased ABP:
1. Increase anesthetic depth
2. Give hydralazine
3 nitroprusside/NTG
39
Treatment to increased HR:
Beta antagonist
40
2 treatments for decreased ABP:
1. Decrease anesthetic depth
| 2. Give vasoconstrictor (phenyl)
41
What event has occurred with decreased ABP and increased PCWP:
Heart failure; LV failure
42
3 treatments for decreased ABP and increased PCWP:
1. Phenyl
2. Positive inotrope
3. NTG (dilate veins)
43
Difference between NTG and nitroprusside?
NTG: vasodilates veins
Nitroprusside: vasodilates veins and arteries
44
Treatment for normal hemodynamics:
NTG or Calcium channel blocker
45
3 things to do with normal hemodynamics to return heart:
1. Slow rate
2. Small state
3. Perfused state
46
Definition of pulmonary HTN:
Mean PAP > 25mmHg at rest
| Mean PAP > 30mmHg with exercise
47
What is normal mean PAP:
12-16mmHg
48
Normal pulmonary circulation can accommodate changes in flow rates from:
6 to 25 L/min
49
enlargement and failure of RV as a response to increased vascular resistance:
Cor Pulmonale
50
5 major categories of pulmonary HTN:
1. Pulmonary arterial HTN
2. Pulmonary venous HTN
3. Pulmonary HTN associated with disorders of respiratory system and/or hypoxemia
4. Chronic thrombotic and/or embolism disease
5. Pulmonary HTN due to disorders directly affecting pulmonary vasculature
51
Occurs without L heart disease, myocardial disease, congenital heart disease, or any other clinically significant respiratory disease:
Idiopathic PAH or primary PAH
52
What can cause primary pulmonary HTN:
Ephedra in herbal diet drugs
53
What primary or secondary pulmonary HTN more common:
Secondary pulmonary HTN
54
11 secondary pulmonary HTN:
```
Pulmonary emboli
COPD
Connective tissue disorders
OSA
Congenital Heart Disease
Sickle cell anemia
Cirrhosis
AIDS
L HF
Drug induced typically cocaine
Altitudes higher than 8,000ft
```
55
PVR equation
80x(PAP-LAP)/CO
56
PAP equation:
LAP + (COxPVR)/80
57
What 2 things increase LAP:
1. Left ventricular failure
| 2. Valvular heart disease
58
What 4 things can increase CO:
1. Cirrhosis of liver
2. Severe infection/anemia
3. Pregnancy
4. Hyperthyroidism
59
4 major categories of chronically increased PVR:
1. Pulmonary disease
2. Hypoxia without pulmonary disease
3. Pulmonary arterial obstruction
4. Idiopathic pulmonary arterial HTN
60
4 acute increases of PVR:
1. Hypercarbia
2. Acidosis
3. Increased sympathetic tone
4. Pulmonary vasoconstrictors (catecholamines, serotonin, thromboxane, endothelin)
61
4 common vague symptoms for pulmonary HTN:
1. Breathlessness
2. Weakness
3. Fatigue
4. Abdominal distention
62
Is there edema in ankles, legs and ascites with pulmonary HTN?
Yes
63
What 3 things do you see with chest X-ray for pulmonary HTN:
1. Prominent pulmonary vessels
2. RA enlargement
3. RV enlargement
64
What is Cor Pulmonale?
Right sided heart failure (having to pump against narrowed arteries)
65
What is more prone to blood clots?
PAH
66
What 5 things treat pulmonary HTN?
1. Supplemental O2
2. Anticoagulation
3. Diuretics
4. Vasodilators
5. Surgery (transplant)
67
With PAP >45% what is the mortality rate?
80%
68
What 5 things exacerbate (make worse) pulmonary HTN?
1. Hypoxemia
2. Hypercapnia
3. Hypothermia
4. Acidosis
5. Sympathetic stimulation
69
Should you use sedatives with pulmonary HTN?
NO
70
7 steps of symptomatic therapy for pulmonary HTN:
1. Improve O2 with 100% O2
2. Avoid respiratory acidosis
3. Correct metabolic acidosis
4. Avoid V/Q mismatch
5. Avoid over inflation of alveoli
6. Avoid catecholamines release
7. Avoid shiver
71
What to do with increased PVR to decrease PVR:
Hyperventilate with increased pH
72
No RV failure, can you use inhalational agents?
Yes
73
Yes RV failure, what 2 things should be used?
Narcotic and relaxant
74
What 5 things to avoid during induction of pulmonary HTN?
1. N2O
2. Ketamine
3. Etomidate
4. Nimbex
5. Be careful with using regional
75
What treatment is preferred for pts with hypotension with chronic pulmonary HTN?
NorE over phenylephrine
76
Does NO play a large role in inflammation?
Yes
77
What do these release?
| NTG, viagra, sodium nitroprusside
NO
78
Does CCB and ACE inhibitors increase or decrease NO bioavailability?
Increase
79
Does hydralazine enhance NO effects?
Yes
80
Does NSAID’s increase NO?
No, decreases
81
Are pts at risk of sudden death for pulmonary HTN?
Yes
82
Selective pulmonary vasodilator that improves ventilation-perfusion matching at low doses in pts with acute respiratory failure?
Inhaled nitric oxide
83
5 minor cardiac clinical predictors?
1. Age
2. Abnormal ECG
3. Rhythm other than sinus
4. History of CVA
5. Uncontrolled HTN
84
5 intermediate cardiac clinical predictors?
1. Remote MI (>1month)
2. Stable angina
3. Compensated CHF
4. Creatinine <2.0
5. Diabetes
85
5 high cardiac clinical predictors?
1. Acute or recent MI (<1month)
2. Unstable or severe angina
3. Large ischemic burden
4. Decompensated CHF
5. Significant arrhythmias
86
Typical angina-like chest pain with evidence of MI in absence of flow-limiting stenosis on coronary angiography
- exercise induce angina
- NTG, CCB
Prinzmetal’s angina
87
3 peri operative MI risk predictors:
1. Severity of underlying CAD
2. Type of surgery (hemodynamic stress and duration)
3. MET’s
88
3 perioperative MI mechanisms:
1. Unstable plaque
2. Catecholamines
3. BP swings
89
How long to wait for surgery for bare metal stent?
>6wks
90
How long to wait for surgery with drug induced stents?
>12wks
91
Surgery specific risk of:
- Endoscopic (cholecystectomy, arthroplasty, urologic)
- breast
- skin
- cataracts
Low (<1% mortality)
92
Surgery specific risk of:
- intraperitoneal/intrathoracic
- orthopedic
- head & neck
- carotid endarterectomy
Intermediate (1-5% mortality)
93
Surgery specific risk of:
- emergent (in elderly)
- aortic
- peripheral vascular
High (>5% mortality)
94
Means of expressing the intensity & energy expenditure of activities in a way comparable among persons of different wts:
Metabolic Equivalent of Task (METs)
95
Energy consumption of an average person seated at rest:
1 MET
96
Walking at slow pace would require what energy?
2 METs
97
Light work around house like dusting or washing dishes or climb a flight of stairs of walk up a hill METs?
4
98
Low METs:
<4
99
Intermediate METs:
4-10
100
Excellent METs:
>10
101
METs:
- eating
- walking around the house
- dressing
- dishwashing
Low METs
102
Does low METs increase surgical risk?
YES
103
METs:
- climbing a flight of stairs
- walking at 4mph
- scrubbing floors
- moving heavy furniture
- golf
Intermediate METs
104
METs:
- swimming
- singles tennis
- basketball
Excellent METs
105
What is more detrimental (HR or BP) when stopping beta blockers?
Increase in HR
106
3 things to prevent peri-op MI:
1. Statin therapy (1-4wks before surgery)
2. Alpha 2 agonist (if can’t tolerate BB)
3. Sugar below 180
107
In summary for preop cardiac, non-cardiac surgery (6)
1. Continue BB
2. Alpha 2 agonists
3. Continue CCB
4. Continue nitrates
5. Water sugar
6. Sedation okay but give O2
108
Maintenance for cardiac, non-cardiac surgery (7):
1. Deep intubation
2. LTA
3. Watch for hypotension
4. Decrease cardiac O2 requirement
5. Slow HR
6. Regional okay
7. Watch for arrhythmias
