Cardiac

Question 1

PCWP tracing change with papillary muscle rupture

Answer 1

Large V-waves

Inferior MI = posteromedial papillary muscle - posterior descending branch from RCA

The V wave in the left atrial pressure (LAP) or pulmonary capillary wedge pressure (PCWP) tracing represents left atrial filling against a closed mitral valve. If severe mitral valve regurgitation is present, the V wave will be significantly accentuated.

Question 2

PCWP Large A waves cause?

Answer 2

Mitral stenosis

Question 3

Cannon A waves cause?

Answer 3

A-V dyssynchrony, PVCs, or re-entrant tachycardia - atrium contracting against a closed tricuspid valve

Looks like there is no c-wave

Question 4

Placing magnet over ICD + dual chamber pacemaker has what effect?

Answer 4

Disables ICD
No effect on pacemaker

Question 5

1 congenital anomaly at birth?

Answer 5

Perimembranous VSD

Question 6

CVP waveform for pericardial tamponade

Answer 6

Exaggerated X-descent
Small y-descent

**
A: (A)trial contraction
C: ventricular (C)ontraction
X: atrial rela(X)ation
V: atrial “V”illing
Y: ventricular “V—>Y”illing (like V with fluid dripping down)

Question 7

CVP waveform for constrictive pericarditis

Answer 7

Exaggerated X and Y-descent

Question 8

More or less temperature change at thermistor in low cardiac output state

Answer 8

more change in temp - more time for mixing allows more change in temp

Smaller injectate = higher CO (less fluid, less temp change)
Larger injectate = lower CO (greater temp change)

Question 9

EKG abnormality with hypoCa

Answer 9

Prolonged QT

Question 10

pH stat monitoring

Answer 10

CO2 is infused into blood to maintain normocarbia during hypothermia –> inc cerebral blood flow

can have inc cerebral embolic load and worse cognitive function

Question 11

Tx goals for MR

Answer 11

Fast, full, forward
afterload reduction + slight inc HR + maintain preload

Question 12

Electrolyte abnormalities causing prolonged PR

Answer 12

hyPeR - K, Ca, Mag

Tends to cause shortened QT (opposite of PR)

Question 13

Injectate volume and temp that overestimates CO

Answer 13

Lower volume

Inc temp 1deg = 3%

Question 14

Causes of high MvO2

Answer 14

Low O2 consumption
Cyanide
CO
Hypothermia
High CO states (sepsis, burn, pancreatitis)
L-R shunt
Ionotropes

Question 15

Pulse pressure effect further from the heart

Answer 15

Pulse pressure is inc
Systolic pressure higher

Question 16

Causes of Inc pulse pressure

Answer 16

Hyperthyroidism
Ai
Peripheral vasodilation
Avms
Mild hypovolemia

Question 17

Narrow pulse pressure causes

Answer 17

Hypovolemia
Tamponade
CHF
AS
Shock

Question 18

Aortic valve leaflet seen in ME AV long axis view opposite the LA

Answer 18

Right coronary cusp
- located right next to the RV

Question 19

How does hypothermia affect gas solubility?

Answer 19

Inc solubility —> dec partial pressures

Heating —> dec solubility and falsely elevates partial pressures

Question 20

How does temp affect blood pH?

Answer 20

pH rises 0.015 for every 1 degree decrease in temp

Question 21

What accounts for pulsus paradoxus?

Answer 21

Shift of interventricular septum

Question 22

Tx desaturation with Fontan physiology

Answer 22

maintain spontaneous ventilation (if using mechanical ventilation, use I:E 1:3)
Inc preload

Question 23

Tx desaturation in unrepaired TOF or w/ BT shunt

Answer 23

Fluid bolus
100% O2
Phenylephrine or knees to chest
Esmolol or deepen anesthetic to reduce infundibular spasm

Question 24

Indications for retrograde cardioplegia

Answer 24

AI
Prior IMA graft
Prolonged valve or root repairs

Question 25

Best way to augment BP following heart transplant

Answer 25

Inc stroke volume
Epi
Isoproterenol
No innervation to the heart - resting mild tachycardia and inability to augment heart rate in response to stress or hypovolemia.

Question 26

Pacemaker mode for persistent fib and bradycardia

Answer 26

DDDR

Question 27

Formula for PVR

Answer 27

[(mPAP - PCWP)/CO] x 80
Normal = 20-130

Transpulmonary gradient (TPG) >16 + high RAP prior to CPB = high probability of RV dysfunction later

Question 28

Formula for SVR

Answer 28

[(MAP - CVP)/ CO] x80
Normal = 700-1600

Question 29

What is the R function in pacemakers?

Answer 29

Responsiveness
Allows pacemaker to speed up in accordance with metabolic demands - motion, MV, temp when exercising

This may be triggered by many preoperative events = disable

Question 30

Med contraindicated in Long QT syndrome

Answer 30

amiodarone
- prolongs repolarization
- blocks both cardiac K and Ca channels
- Dec SVR

Question 31

Medication that blocks SA and AV nodal cells and electrolyte responsible for impulse generation

Answer 31

Ca = verapamil CCB blocks nodes

Question 32

Bainbridge reflex

Answer 32

Inc right heart stretch and pressure = increase HR

Question 33

Bezold-Jarisch reflex

Answer 33

In response to ventricular wall stimuli - MI, thrombolysis, revascularization –> hypotension and bradycardia

Question 34

Tx stable Afib w/ RVR with impaired LV function

Answer 34

Amiodarone

Question 35

Tx for WPW with narrow complex tachycardia

Answer 35

Adenosine

If unstable, cardioversion first

Question 36

Tx for WPW with regular wide complex tachycardia

Answer 36

Procainamide 10mg/kg over 10 min

Question 37

Tx of WPW with AF (irregularly irregular) tachycardia

Answer 37

Amiodarone 150mg load