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Cardiac Final > Campbell > Flashcards

Campbell Flashcards

1
Q

Preload definition

A
  • the pressure applied to fill the heart

- the degree to which the myocardium is stretched before it contracts

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2
Q

Preload is represented by:

A

the “passive” pressure-volume curve

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3
Q

Preload and _____ are the same clinically

A

end diastolic pressure

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4
Q

Typical LVEDP values:

A

4-5 mmHg

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5
Q

Starlings law of the heart:

A

Heart contracts more forcefully due to enhanced thick and thin filament overlap, contracts to the same ESV (end systolic volume)

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6
Q

Preload has to do with what valve? systole or diastole?

A

mitral

diastole

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7
Q

Increased preload –> increased

A

SV, CO, and PAP (?)

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8
Q

when preload is decreased, what happens to SV, BP, EDV, and HR?

A

SV decreased
BP decreased
EDV decreased
HR increased

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9
Q

What does lasix do to preload?

A

decrease

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10
Q

What does nitroglycerin do to preload?

A

decrease

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11
Q

when preload is increased, what happens to SV, BP, EDV, and HR?

A

SV increases
BP increases
EDV increases
HR decreases

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12
Q

What does IVF do to preload?

A

increase

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13
Q

What does blood transfusion do to preload?

A

increase

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14
Q

Afterload definition:

A

the pressure in the aorta throughout the ejection phase

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15
Q

Afterload is associated with which valve?

A

aortic

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16
Q

A sudden increase in MAP causes 3 things to happen:

A
  1. pressure in the ventricle must rise to a higher level during the isovolumetric contraction phase before the aortic valve will open
  2. ejected volume goes down
  3. SV and CO will decrease
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17
Q

a decrease in afterload does what to SVR, BP, LV volumes?

A

decrease SVR
decrease BP
decrease LV volume

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18
Q

a decrease in afterload does what to time for the LV to empty, O2 demand, resistance to forward flow?

A

decrease time for LV to empty
decrease O2 demand
decrease resistance to forward flow

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19
Q

a decrease in afterload does what to contractility, HR, stroke volume?

A

increase contractility
increase HR
increase stroke volume

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20
Q

what does nitroprusside do to afterload?

A

decreases

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21
Q

an increase in afterload does what to SVR, BP, LV volumes?

A

increase SVR
increase BP
increase LV volume

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22
Q

an increase in afterload does what to time for the LV to empty, O2 demand, resistance to forward flow?

A

increase time for LV to empty
increase O2 demand
increase resistance to forward flow

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23
Q

an increase in afterload does what to contractility, HR, stroke volume?

A

decrease contractility
decrease HR
decrease stroke volume

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24
Q

what does phenylephrine do to afterload?

A

increases afterload

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25
Q

What happens with a sustained increase in MAP: (3 things)

A

a. the increased ESV plus normal venous return volume leads to increased EDV
b. due to the increased EDV the heart contracts more forcefully (Starlings Law of the Heart)
c. SV, CO and PA are increased

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26
Q

An increase in MAP shifts the pressure volume curve which way (at steady state)?

A

right

reserve is diminished

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27
Q

contractility definition:

A

Altered contractile force due to change in the rate or quantity of calcium delivered to the myofilaments, or a change in the affinity of the filaments for calcium.

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28
Q

A sudden increase in contractility causes: (3 things)

A

a. the heart to contract more forcefully from any initial length
b. the heart to contract more forcefully during the ejection phase, leading to a reduced ESV and increased SV
c. increased SV increases CO and PA

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29
Q

decreased contractility causes what change in: BP, SV, LV volume

A

decrease BP
decrease SV
increase LV volume

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30
Q

CHF does what to contractility?

A

decrease

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31
Q

increased contractility causes what change in: BP, SV, LV volume

A

increase BP
increase SV
decrease LV volume

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32
Q

what does digitalis do to contractility?

A

increase

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33
Q

what does calcium do to contractility?

A

increase

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34
Q

The short-term blood pressure regulators are those that respond to rapid changes in MAP and attempt to rapidly return the MAP back to normal range

A

baroreceptors and hormones such as angiotensin and vasopressin

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35
Q

what is the time frame of short term BP regulators? (how rapid are they)

A

within 30 min

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36
Q

long term BP regulation is maintained by what system?

A

Renal homeostasis of blood pressure occurs as the kidneys preferentially excrete sodium and water to maintain a normal fluid balance.

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37
Q

Do the left ventricular diastolic volume (LVDV) and the left ventricular diastolic pressure (LVDP) have a predictable relationship?

A

No

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38
Q

Increase in contractility causes the same shift in ventricular function curve as (increase/decrease) in afterload

A

decrease

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39
Q

increase in contractility or decrease in afterload cause what shift in ventricular function curve?

A

upward and to the left shift

reflects increase in SV and decrease in LV chamber size

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40
Q

decrease in contractility or increase in afterload cause what shift in ventricular function curve?

A

downward and to the right

reflects decrease in SV and increase in LV chamber size

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41
Q

contractility and afterload have a (direct/inverse) relationship

A

inverse

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42
Q

DAPT + ASA and P2Y12 inhibitor is standard for _____ weeks after ____ stent

A

6 weeks after bare metal stent
3-6 months after MI
12 months after drug eluding stent

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43
Q

Chronic constrictive pericarditis results from

A

pericardial thickening and fibrosis

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44
Q

most common cause of pericardial constriction (in past and currently):

A

past: Tb
currently: idiopathic in nature and can occur following cardiac surgery, neoplasia, uremia, radiation therapy, and rheumatoid arthritis

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45
Q

What do you want with HR/contractility in chronic constrictive pericarditis anesthesia management?

A

PRESERVE HR and contractility

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46
Q

chronic constrictive pericarditis anesthesia management drug/ventilation concerns?

A
  • ketamine good
  • bradycardia is bad
  • careful with VA (worry about vasodilation)
  • preserve HR, preload, afterload, contractility
  • caution with PPV- decreases CO and venous return to heart
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47
Q

Concentric goes with regurgitation or stenosis?

A

stenosis

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48
Q

Eccentric goes with regurgitation or stenosis?

A

regurgitation

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49
Q

Mitral regurg/insufficiency hemodynamic goals:

A
  • Decreasing regurgitant blood flow to enhance CO by decreasing afterload, maintaining or increasing preload, and maintaining cardiac contractility.
  • Bradycardia or dysrhythmias that cause a loss of atrial kick can result in pulmonary congestion, left atrial and left ventricular overload, and a significant decrease in CO
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50
Q

mitral regurgitation HR goal:

A

increase/avoid bradycardia

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51
Q

mitral regurgitation rhythm goal:

A

NSR

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52
Q

mitral regurgitation afterload goal:

A

decrease

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53
Q

mitral regurgitation PVR goal:

A

avoid increase

54
Q

mitral regurgitation preload goal:

A

normal or increased

55
Q

mitral stenosis peak systolic pressure:

A

lower than normal

56
Q

in mitral stenosis, a reduced left ventricular preload causes a:

A

decrease in LVEDP and stroke volume

57
Q

best drug for mitral stenosis:

A

phenylephrine (low HR ok/somewhat desirable)

58
Q

mitral stenosis goal HR:

A

low, normal

59
Q

mitral stenosis goal rhythm:

A

NSR

60
Q

mitral stenosis goal afterload:

A

maintain normal

61
Q

mitral stenosis PVR goal:

A

avoid increases

62
Q

mitral stenosis goal preload:

A

normal to increase

63
Q

What value should should alert the anesthetist to the presence of mitral or aortic insufficiency or primary coronary artery disease?

A

increased LVEDV in patients with mitral stenosis

LVEDV normal in approx 85% patients with just mitral stenosis

64
Q

mitral stenosis causes what PA Cath waveform changes?

A

a prominent a wave and a decreased y descent

65
Q

aortic regurgitation/ insufficiency anesthesia management goals:

A
  • increase forward flow and decrease the degree of regurgitation
  • HR maintained 80 to 100 bpm
  • decrease afterload (especially diastolic pressure)
  • avoid myocardial depression
  • maintain normal sinus rhythm
  • maintain/increase preload
    (regurg- still full fast forward)
66
Q

regional in aortic regurgitation?

A
  • neuraxial blockade, spinal and epidural are appropriate

- decrease SVR due to sympathetic blockade may be advantageous for aortic regurgitation

67
Q

Drugs/anesthesia in aortic regurgitation:
paralytic?
gas?

A
  • GA can be done with a variety of agents
  • Pancuronium is desirable
  • Caution with Succs ie bradycardia
  • Isoflurane increases HR (want to maintain 80-100) and decrease SVR (we want to decrease afterload)
  • For ventricular dysfunction- opioid based technique
68
Q

aortic regurgitation HR goal:

A

moderate increase

80-100

69
Q

aortic regurgitation goal rhythm:

A

NSR

70
Q

aortic regurgitation afterload goal:

A

decrease

71
Q

aortic regurgitation PVR goal:

A

maintain

72
Q

aortic regurgitation preload goal:

A

normal to increase

73
Q

mitral valve prolapse anesthesia considerations:

A
  • Stimulation of SNS worsens MVP
  • Avoid anticholinergics (make valves worse)
  • Reduce Pre-op anxiety
  • Regional and GA is acceptable
  • Maintain SVR above normal even with sympathetic blockade
  • Maintain preload
  • DO NOT use Ketamine (because increases HR)
74
Q

Antibiotics in mitral valve prolapse:

A
  • ABX prophylaxis due to endocarditis
  • only patients with prosthetic valves, patients with prior endocarditis, heart transplant patients with a valvuloplasty, and certain congenital heart disease patients now require endocarditis prophylaxis.
75
Q

mitral valve prolapse preload goal:

A

maintain or increase

76
Q

mitral valve prolapse afterload goal:

A

maintain

77
Q

mitral valve prolapse contractility goal:

A

maintain

78
Q

mitral valve prolapse HR goal:

A

maintain

79
Q

mitral valve prolapse rhythm goal:

A

NSR

80
Q

Most distinguishing characteristic of aortic stenosis pressure volume loop:

A

The extremely high systolic pressure rise is the most distinguishing characteristic

81
Q

when see aortic stenosis in history, look at echo for:

A

size of valve

82
Q

what drug must be avoided in aortic stenosis (if critical/severe):

A

propofol

83
Q

severe aortic stenosis is an aortic valve area less than:

A

1 cm2

84
Q

aortic valve area less than ____ is associated with sudden death

A

0.7 cm2

85
Q

regional in aortic stenosis?

A

no spinal, increase drop in BP and increase HR and sympathetic response
epidural is better than spinal

86
Q

can you do CPR/resuscitate pt with aortic stenosis:

A

successful CPR is near impossible

87
Q

best drug for all stenosis:

A

phenylephrine

88
Q

best drug for all regurgitation:

A

ephedrine

89
Q

aortic stenosis anesthesia considerations:

A
  • Caution the use of medications with histamine release (increase HR)
  • Avoid profound hypotension and decreased SVR
  • Opiate induction technique preferred
  • Avoid Ketamine
  • Etomidate good choice
  • propofol not a great idea
90
Q

treating hypotension in aortic stenosis:

A

phenylephrine or a-agonist

91
Q

treating bradycardia (<60) or junctional rhythm in aortic stenosis:

A

ephedrine, atropine or glyco

92
Q

treating tachycardia (>110) in aortic stenosis:

A

B-blocker (esmolol)

93
Q

how to treat SVT in aortic stenosis:

A

cardioversion

94
Q

aortic stenosis goal HR:

A

low to normal

95
Q

aortic stenosis goal rhythm:

A

NSR

96
Q

aortic stenosis goal afterload:

A

maintain/increase

97
Q

aortic stenosis goal PVR:

A

maintain

98
Q

aortic stenosis goal preload:

A

increased

99
Q

valve summary:
preload
contractility
rhythm

A

always maintain, maintain, NSR

100
Q

regurgitation memory trick:

A

full fast forward

101
Q

stenosis HR:

A

decrease

102
Q

a repeatedly reported complication following TAVR, and affects 10% to 50% of patients, with a higher incidence in CoreValve use:

A

AV block requiring permanent pacemaker placement

103
Q

before induction for a TAVR, what should be placed on pt?

A

pacer/defib pads

104
Q

Hypertrophic Cardiomyopathy AKA HCM/ IHSS comes from:

A

genetically transmitted

105
Q

Hypertrophic cardiomyopathy AKA HCM/ IHSS is the most common cause of:

A

pediatric and young adult death

106
Q

Hypertrophic cardiomyopathy preload goal:

A

increase

107
Q

Hypertrophic cardiomyopathy afterload goal:

A

increase

108
Q

Hypertrophic cardiomyopathy contractility goal:

A

decrease

109
Q

Hypertrophic cardiomyopathy HR goal:

A

maintain

110
Q

Restrictive Cardiomyopathy anesthesia considerations

A
  • Diuretics
  • Na and H2O restriction
  • Anticoagulation
  • Tx dysrhythmias
  • Maintain preload
  • Minimal myocardial depression
  • High dose narcotic with titration
111
Q

what is Takotsubo Cardiomyopathy

A

elevated endogenous catecholamine concentrations cause myocardial toxicity leading to myocardial inflammation and dysfunction
aka stress cardiomyopathy, broken heart syndrome, etc.

112
Q

Takotsubo Cardiomyopathy presents as:

A

MI

angiogram reveals nothing

113
Q

Takotsubo Cardiomyopathy patients usually regain cardiac function in:

A

4-8 weeks

114
Q

absolute contraindications to TEE:

A
  • Strictures
  • Diverticula
  • Tumors
  • Traumatic interruption
  • Recent suture lines
115
Q

allows pacemaker to switch from synchronous to asynchronous pacing with a magnet:

A

reed switch

inactivates the sensing circuit causing it to be asynchronous

116
Q

asynchronous mode:

A

cardiac pacing mode set independent of the hearts intrinsic rate

117
Q

inhibited definition (for pacemaker):

A

when the patient demonstrates an intrinsic heartbeat, the pacemaker will not deliver a paced beat

118
Q

threshold definition (for pacemaker):

A

the minimum output that will cause the myocardial chamber (atrium or ventricle) to consistently contract or capture

119
Q

how often should ICD be routinely assessed?

A

6 months

120
Q

how often should pacemaker be routinely assessed?

A

every year*

121
Q

magnet on pacemaker:

A

asynchronous pacing

122
Q

magnet on ICD:

A

disables shock

123
Q

magnet on pacemaker and ICD:

A

disables shock only

124
Q

Radiofrequency catheter ablation

A

Modification of the sinus node or atrioventricular (AV) node

- SVT, a flutter, atrial tachycardia, afib

125
Q

before radiofrequency catheter ablation is chosen as therapy, what must be done?

A

EPS study to determine the origin and pathway of the arrhythmia and MOA

126
Q

after radiofrequency catheter ablation, will the patient need meds?

A

pt will no longer need meds after RCFA

127
Q

what is now being used prior to RCFA?

A

Cryoablation

128
Q

how does cryoablation work?

A
  • Liquid Nitrous is used through a catheter and the arrhythmia is frozen/ permanently destroyed by “ice mapping”
  • causes less discomfort and safer
  • best used for iatrogenic AV Block
129
Q

RCFA procedural complications:

A
  • Bleeding
  • ECG changes
  • Cerebrovascular accidents
  • Cardiac tamponade
  • Damage to the aortic valve
130
Q

Vtach ablation, most patients on amiodarone which:

A

causes pulmonary toxicity, hypothyroidism* and hypotension during anesthesia

Cardiac Final (2 decks)

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