Cardiac

Question 1

What is pulsus paradoxus?

Answer 1

Decreased SBP > 10 mmHg
Negative intrathoracic pressure on inspiration –> increased venous return to RV –> Bowing of ventricular septum toward LV–> Decreased SV–> Decreased CO–> Decreased SBP

Question 2

Anesthetic goals for HFrEF (Systolic Failure)?

Answer 2

Question 3

In what order do CCB impair contractility?

Answer 3

Verapamil> nifedipine> diltiazem> nicardipine

Question 4

What is the MOA of clevidipine?

Answer 4

Dihydropyridine
-Arterial vasodilation reduces SVR without affecting preload
-Prepared as a lipid emulsion (Discard vial after 12h)

Question 5

Contraindications to clevidipine?

Answer 5

-allergy to egg, egg products, soy products
-Impaired lipid metabolism: pathologic hyperlipidemia, acute pancreatitis, lipid nephrosis
-Severe aortic stenosis

Question 6

Clevidipine pharmacokinetics?

Answer 6

Onset: 2-4 min
Half-life: 1 min
Metabolized by plasma and tissue esterases

Question 7

Presentation of cardiac tamponade?

Answer 7

Question 8

Differences between constrictive and acute pericarditis

Answer 8

Question 9

Hemodynamic goals for cardiac tamponade

Answer 9

Question 10

What patient conditions are associated with highest risk for developing infective endocarditis?

Answer 10

-Previous infective endocarditis
-Unrepaired cyanotic congenital heart disease
-Prosthetic heart valve
-Repaired congenital heart defect < 6 months
-Heart transplant with valvuloplasty
-Repaired congenital heart disease with residual defects

Question 11

Anesthetic management for Obstructive hypertrophic cardiomyopathy

Answer 11

Question 12

What is anterograde cardioplegia?

Answer 12

Potassium containing solution to arrest the heart in diastole. Solution introduced into the aortic root where it enters the coronary arteries. The aortic valve must be competent and the aorta clamped

Question 13

Where is retrograde cardioplegia introduced?

Answer 13

Coronary sinus

Question 14

Insertion–>junction of vena cava and RA

Answer 14

Left/right subclavian: 10 cm
RIJ: 15 cm
LIJ: 20 cm
Femoral: 40 cm
Right median basilic: 40 cm
Left median basilic: 50 cm

Question 15

Distance from junction of vena cava and RA–> tip of catheter

Answer 15

RA: 0-10 cm
RV: 10-15 cm
PA: 15-30 cm
PAOP: 25-35 cm

Question 16

What causes large a waves on CVP?

Answer 16

junctional rhythms, complete AV block, or PVCs, tricuspid or mitral stenosis, myocardial ischemia, diastolic dysfunction, ventricular pacing asynchronus

Question 17

What causes large v waves on CVP?

Answer 17

Right ventricular ischemia, right ventricular failure, constrictive pericarditis, cardiac tamponade, papillary muscle ischemia, or tricuspid regurgitation

Question 18

What is Beck’s syndrome?

Answer 18

-Flaccid paralysis of lower extremities
-Bowel and bladder dysfunction
-Loss of temperature and pain sensation
-Touch and propioception are preserved

Question 19

Acute pericarditis vs. MI

Answer 19

Question 20

Normal AV area?

Answer 20

2.5-3.5 cm^2