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SEE Exam Review > Cardiac > Flashcards

Cardiac Flashcards

1
Q

A stress (exercise) ECG has ______ specificity and rules in _____?

A

90% ; CAD

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2
Q

What is auto regulation range for cerebral perfusion pressure?

A

MAP 50-160 mmHg

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3
Q

What is the auto regulation range for coronary perfusion pressure?

A

MAP 60-160 mmHg

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4
Q

What is the auto regulation range for renal perfusion pressure?

A

MAP 80-180 mmHg

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5
Q

What are the four types of abnormal cardiac wall motion?

A

Hypokinesis
Hyperkinesia
Alkinesis
Dyskinesis

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6
Q

What is hypokinesis?

A

less than normal wall motion

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7
Q

What is hyperkinesis?

A

Greater than normal wall motion

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8
Q

What is akinesis?

A

absence of wall motion

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9
Q

What is dyskinesia?

A

paradoxical outward motion

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10
Q

What are the different waves of the

A

A- atrial contraction, ventricular filling
C- Ventricular contraction, tricuspid valve elevation
V- tricuspid closed and systolic atrial filling
X - ventricular systole, atrial relax & displace tricuspid valve
Y - Diastole, early ventricular filling, open tricuspid

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11
Q

Which is preferred for CVC placement: RIJ or LIJ and why?

A

RIJ – left has the thoracic duct

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12
Q

What do large A waves indicate?

A

tricuspid stenosis
pulmonary stenosis
pulmonary HTN
decreased right ventricular compliance

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13
Q

What do large V waves indicate?

A

Tricuspid regurgitation
Right ventricular papillary muscle ischemia
Pericarditis
Cardiac tamponade

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14
Q

If you have a multiorfice catheter, how high do you want the CVC placed?

A

2cm below the SVC

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15
Q

if you have a single office catheter, how high do you want the CVC placed?

A

3cm above the SVC

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16
Q

What causes increased CVP?

A

right ventricular failure
cardiac tamponade
tricuspid stenosis
tricuspid regurgitation
pericarditis
pulmonary HTN
chronic left ventricular failure
hypervolemia

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17
Q

If your patient has an increased CVP, what might be making it read high and how do you fix it?

A

PEEP – disconnect from vent for 10-15 seconds for accurate reading

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18
Q

Where are the venous baroreceptors located?

A

RA and the great veins

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19
Q

What is the Bainbridge reflex?

A

increased stretch of the right atrium increases HR with inspiration via vagus nerve

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20
Q

Where are the aortic baroreceptors located?

A

aortic arch
Carotid sinus

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21
Q

What nerve is affected in the aortic arch?

A

Vagus nerve
Reliant on stretch (sensory)

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22
Q

What nerve is affected in the carotid sinus?

A

glossopharyngeal nerve afferent action

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23
Q

How do you see efferent responses to the arterial baroreceptors?

A

T1-T4 sympathetic cardioaccelerants and Vagus

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24
Q

What is a normal RA pressure?

A

1-8

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25
Q

What is the depth of the normal RA in the heart

A

20 cm RIJ

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26
Q

What is the normal RV pressure?

A

(15-25) / (1-8)

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27
Q

What is the average depth to the RV from the RIJ?

A

30 cm

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28
Q

What is the average PA Pressure?

A

Nickel over dimes

(15-25) / (8-15)

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29
Q

What is the average distance to the PA from the RIJ?

A

45cm

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30
Q

What is an average PCWP?

A

6-12

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31
Q

What is the average LA pressure?

A

2-12

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32
Q

What is the average LV pressure?

A

(100-140) / (0-12)

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33
Q

What is never higher than the pulmonary artery diastolic pressure?

A

PAWP

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34
Q

If a patient has hypovolemia, what does their CVP or PCWP look like?

A

Low CVP
Low PCWP

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35
Q

If a patient has L Ventricular Failure,what does their CVP or PCWP look like?

A

CVP normal or high
PCWP high

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36
Q

If a patient has R Ventricular Failure,what does their CVP or PCWP look like?

A

High CVP
Normal PCWP

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37
Q

If a patient has a PE,what does their CVP or PCWP look like?

A

High CVP
Normal PCWP

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38
Q

If a patient has chronic pHTN, what does their CVP or PCWP look like?

A

High CVP
Normal PCWP

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39
Q

If a patient has cardiac tamponade, what does their CVP or PCWP look like?

A

High CVP
High PCWP

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40
Q

What is concentric hypertrophy?

A

Pressure problem
Same size SV

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41
Q

What is eccentric hypertrophy

A

Volume Problem, larger SV

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42
Q

What are the three parts of the arterial line tracing?

A

Anacrotic limb
Dicrotic notch
Dicrotic limb

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43
Q

What does the Anacrotic limb tell us?

A

SVR and Contractility

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44
Q

What does the dicrotic notch tell us?

A

AORTIC VALVE CLOSURE

Coronary artery perfusionW

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45
Q

What does the dicrotic limb tell us?

A

blood flow to the periphery

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46
Q

What location of an arterial line has the greatest pulse pressure?

A

Dorsalis Pedis

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47
Q

If your transducer is high, what happens to your BP?

A

reads low

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48
Q

If your transducer is low, what happens to the BP/

A

Higher than actual BP

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49
Q

What is the difference between invasive and noninvasive BP?

A

Invasive BP is 20 mmHg higher than NIBP

50
Q

If your patient is sitting, where should the transducer be?

A

EAR because the perfusion pressure of the brain will be lower, so you need to place it higher to get a better reading for the brain

51
Q

Venticular action potential, tell me about it.

A

Starts with 4 – baseline
0 = Na+ influx
1 = Na close, Cl in and K out
2 = Ca+ influx (plateau phase)
3 = K moves out, and Ca+ channels close
4 = Na/K pump restores balance

52
Q

Tell me about a SA node Action Potential?

A

4 - returning to normal
0 - Ca+ influx (mostly) and Na+ influx
3 - K efflux
4 - hyperpolarization

53
Q

An inferior MI shows up as what on an EKG?

A

II, III, aVF

54
Q

What is the most common inferior posterior MI?

A

RCA occlusion

55
Q

What is the most common arrhythmia seen with Inferior or posterior MIs?

A

SA and AV Nodal dysrhythmias

Sinus arrest
sinus pause
AVB 1
Nodal rhythms
complete heart block

56
Q

What are the Lateral leads of the EKG?

A

I, aVL, V5/V6

57
Q

What is the most common lateral MI?

A

Left Circumflex occlusion

58
Q

What leads are the anterior leads?

A

V3/V4

59
Q

What are the most common arrhythmias seen with anterior MIs?

A

Wide complex rhythms

BBB
Complete HB
Mobitz II
Idioventricular rhythms

60
Q

What are the septal leads?

A

V1/V2

61
Q

What is the most common anterior/septal MI?

A

LAD occlusion

62
Q

How do you make a modified V5 leads?

A

place the LL and RA leads in normal position, then place the LA lead over the anterior axillary line at the level of the 5th intercostal space

then select Lead I as the monitoring lead

63
Q

What is a U wave associated with?

A

associated with decreased K
Increased Ca
Quinidine
Digitalis
Epinephrine
ICH
Papillary muscle dysfunction

64
Q

Label the pressure volume loop

A

Lower Left point (A) - Mitral Valve opens
Lower Right corner (B) - Mitral valve closes
Upper Right corner (C)- Aortic valve opens
Upper left corner (D) - aortic valve closes

65
Q

What lies between points B& C on the LV pressure loop?

A

Isovolumic ContractionW

66
Q

What lies between points D & A on the LV pressure loop?

A

Isovolumic relaxation

67
Q

At what point does systole start on the LV pressure volume loop?

A

Point B (mitral valve closes)

Also called end-diastolic pressure volume relationship (EDPVR)

68
Q

At what point does systole end on the LV pressure volume loop?

A

D
Also called end systolic pressure volume relationship (ESPVR)

69
Q

What point indicates the end systolic volume?

A

A

70
Q

Where is systolic BP measured?

A

Uppermost point

71
Q

Where is diastolic BP measured?

A

Point C

72
Q

If you have increased Preload, increased SV and the same end diastolic volume, what does that need?

A

give fluids

73
Q

In a pressure volume loop, if you have a steeper EDPVR line, what does that indicate?

A

Decreased heart compliance

74
Q

In a pressure volume loop, if you have a decreased EDPVR, what does this indicate?

A

Increased compliance

75
Q

In a pressure volume loop, if you have an increased slope line for the ESPVR, what does that indicate?

A

increased contractility

76
Q

In a pressure volume loop, if you have a decreased slope line for the ESPVR, what does that indicate?

A

decreased contractility

77
Q

Volume will lead to a ____ or _____ pressure volume loop?

A

thinner or wider

78
Q

Inotropy will lead to a _____ or _____ pressure volume loop?

A

taller or shorter

79
Q

What is the Bainbridge reflex?

A

increased volume in the right atrium causes HR to inCrease by 10-20%

80
Q

Is preload dependent or independent of contractility?

A

independent, depends on ventricular filling

81
Q

How are CO and SV related to after load?

A

Inversely related

82
Q

What does systolic heart failure look like on a pressure volume loop?

A

Increased LV Volume
decreased ejected amount of volume
decreased inotropy

THINK: Big and Boggy heart

83
Q

What does diastolic heart failure look like on a pressure volume loop?

A

Increased EDPVR line

84
Q

How much CO does the heart get?

A

5% (225mL)

85
Q

How much CO do the lungs get?

A

100%

86
Q

How much CO does the liver get?

A

27%

87
Q

How much of the CO do the kidneys get?

A

20-25%

88
Q

How much of the CO doe the CNS get?

A

15% (750 mL)

89
Q

What is the valve area for the aortic valve?

A

3-4 cm

90
Q

What valve area indicates mild aortic stenosis?

A

<1.5

91
Q

What valve area indicates severe aortic stenosis?

A

<1 cm

92
Q

What is the normal aortic valve gradient?

A

<15

93
Q

What aortic valve gradient indicates mild stenosis?

A

<25

94
Q

What aortic valve gradient indicates Severe aortic stenosis?

A

> 40

95
Q

What does Aortic Stenosis look lIke?

A

Makes you SAD

Syncope
Angina
Dyspnea on exertion

96
Q

The right coronary artery gives off what in 85% of people?

A

Posterior Decending Artery

97
Q

How do you want to treat patients with aortic stenosis in the OR?

A

Slow, Tight And FULL

Decreased HR (slow), Increased SVR (tight)

Phenylephrine is your friend in these pts!!!

HR goals <80
Light premedication
TEE Intraop
Preinduction Arterial line

98
Q

What does the RCA supply?

A

Inferior Wall
Septum
Posteromedial papillary muscles
Anterior RV
SA Node in 60% of people
Supplies 25-35% of the LV

99
Q

What does the LCA split into?

A

Originates as the left main (widow maker)

Circumflex
LAD

100
Q

What does the LAD supply

A

Septals and diagonals
45-55% of the LV

101
Q

What does the circumflex artery supply?

A

OMs
Posteriolateral LV
15-25% of the LV (unless left dominant, then 50%)
SA node in 40% of people

102
Q

What does sudden, and ACUTE Aortic regurgitation look like?

A

sudden and severe dyspnea
Rapid clinical deterioration
CV Collapse

** USUALLY CAUSED BY AORTIC DISSECTION**

103
Q

How do you treat Aortic Regurgitation patients in the OR?

A

Fast, Full and Forward

Preload increased
SVR Decreased
Increased HR

104
Q

What is aortic regurgitation most commonly caused by?

A

Concentric heart failure
RHEUMATIC FEVER

105
Q

What is HOCM?

A

Hypertrophic Obstructive cardiomyopathy

106
Q

How do you treat HOCM in the OR?

A

Keep Full
Increased SVR
Penylephrine is your friend

107
Q

How is mitral stenosis often identified initially?

A

first associated with exercise or high CO states

MOST COMMONLY SEEN SYMPTOMS: PULMONARY SYMPTOMS!

Then seen with periodic episodes of:
- Fatigue
- Chest pain
- Palpitations
- SOB
- Paroxysmal Nocturnal dyspnea

108
Q

How do you treat mitral stenosis

A

Slow, Tight and Full-ish

Slow HR,
Tight SVR
Full-ish (preload)

109
Q

What is the normal valve area of the mitral valve?

A

4-6

110
Q

What valve area do pts usually start seeing symptoms of mitral stenosis?

A

<1 cm

111
Q

What medications do you want to avoid in Mitral stenosis pts?

A

Avoid ketamine due to propensity to increase HR

112
Q

You have a patient come in with hoarseness, what heart condition might they have?

A

Mitral stenosis due to recurrent laryngeal nerve being compressed by distended LA and enlarged PA

113
Q

What is acute mitral regurgitation often caused by?

A

Papillary muscle rupture

114
Q

How do you treat acute mitral regurg?

A

FAST FULL AND FORWARD

Increased HR (around 90 bpm)
Increased Preload
Decreased to normal SVR

115
Q

In pts with acidosis and hypercapnia, what do you see with the SVR and PVR?

A

Increased PVR

Decreased SVR

116
Q

What is Beck’s Triad?

A

Associated with tamponade

Muffled Heart tones
JVD
HoTN

117
Q

What are statins?

A

inhibitors of HMG-CoA recluctase

118
Q

What are some S/E of statins?

A

Liver dysfunction
Severe Myopathy

119
Q

What is the protamine dose for bypass

A

1.0-1.3 mg/100U heparin

120
Q

What is the heparin dose for bypass?

A

300 U/kg

121
Q

What is the initial dose of FFP?

A

10-15 ml/kg

SEE Exam Review (3 decks)

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