Cardiac 2.2 Flashcards
What are Atrial Premature Beats (ABP)?
- Depolarizations initiated by ectopic foci outside the SA node.
- Very common and can occur with or without cardiac disease.
- Can be from stress, caffeine, electrolyte abnormalities, drugs
- Most common at rest and decrease with exercise
Atrial premature beat
Blocked atrial premature beat
PVC
SVT
Wolf-Parkinson White
VT
Afib
1st degree heart block
2nd degree heart block type II
2nd degree heart block type I
3rd degree heart block
Whats wrong in this EKG?
prolonged QT
Right BBB
Left BBB
What are Ventricular Premature Beats (VPB)?
Depolarizations initiated by ectopic foci outside the SA node. Very common and can occur with or without cardiac disease.
What is Supra Ventricular Tachycardia?
- Can involve focal or reentrant mechanisms
- result from a repetitive firing of an ectopic pacemaker.
- can be retrograde or antegrade
Types of SVT?
- Atrial tachycardia,
- AV reentry tachycardia
- Bypass mediated tachycardia (e.g., WPW).
What is Wolf-Parkinson White (WPW)?
- A symptomatic arrhythmia in the presence of an accessory pathway
- linking atria and ventricles, bypassing the AV node.
What are the WPW triad?
- Short P-R interval
- Delta wave
- Wide QRS (often confused for BBB)
What are precaution as anesthesia for WPW?
- Requires good preop
- Ablation treatment of choice
- Avoid B-Blockers, Ca Channel blockers
- Treat with amiodarone, procainamide
What is Ventricular Tachycardia?
- Defined as 3 or more VPBs at a rate of 100 or greater,
- due to focal or reentry mechanisms.
- Requires cardioversion.
What are the types of Ventricular Tachycardia?
- Monomorphic and Polymorphic.
- Monomorphic is usually caused by reentry around a lesion in patients with CAD,
- Polymorphic is usually associated with CAD.
What is Long QT Syndrome?
- Disorder arising from mutations in cardiac ion channels resulting in prolonged QT
- Can be inherited or acquired
- Acquired is usually because of electrolyte abnormalities or TCA’s
- Treat with B blockers and ICD. Untreated can result in malignant arrythmias
What is atrial fib?
- Most common arrythmia preoperatively
- Irregular R-R
- No distinctive P waves
* Best viewed in lead II - Decreased CO and increased risk of embolism
- Associated with:
CAD
HTN
Cardiomyopathy
Mitral stenosis - Increased risk of thrombosis, most patients on blood thinners
How many types of Conduction Blocks?
3 types
1st
2nd
3rd
What happens in type I AVB?
no complete block, just slow conduction between atria and ventricle
What happens in type II AVB?
- some P not followed by QRS,
- intermittent failure of supraventricular impulses.
- type 1 (more common, progressive lenthening of PR intervan until atrial stimulus not conducted)
- type 2 (rare and more serious, intermittently blocked P waves, most have BBB, block usually in bundle of HIS).
What happens in 3rd degree block?
- failure of supraventricular impulses to reach ventricles.
- atria and ventricles paced separately and independently,
- requires pacemaker.
What causes right Bundle Branch Blocks?
- Can be an isolated anomaly without any underlying disease
- 3 times more common than LBBB
- May occur in chronic conditions affecting the right side of the heart including ASD, chronic pulmonary disease, pulmonary HTN, or PE
What causes LBBB?
- Incidental in 2.5% of population
- More likely than a RBBB to be associated with underlying heart disease
- Can lead to systolic diastolic dysfunction
- May precipitate heart failure
- Requires a more in depth assessment
1. LV Hypertrophy
1. CAD
1. Valve problems
What is the incidence of congenital heart disease and why are cases increasing?
- increased over last few decades, seeing more cases due to improved treatments
- 6 per 1000;
Which gender is more affected by congenital heart disease and why?
Females; males less likely to survive
What tests are used to evaluate congenital heart disease?
CXR, EKG, MRI, CT, Holter, Stress Test, Heart Cath
What are common presentations of congenital heart disease?
WPW, dyspnea, orthopnea, A-V shunt, pulm/hepatic issues
What determines the extent of preop cardiac testing?
Case complexity and comorbidities
range from EKG to nuclear stress test
Should immunosuppressants be stopped preop in heart transplant patients?
No, continue them
What are common side effects of immunosuppressants?
Renal issues, electrolytes, ↑ infection risk (20%)
What baseline tests are done for heart transplant patients?
EKG, stress test, echo, heart cath, biopsy
How does transplant type and location of grafting affect rhythm?
they drives heart rhythm Biatrial vs. bicaval
What is a denervated heart missing?
Sympathetic, parasympathetic, sensory input
Why is HR higher in transplant patients?
No parasympathetic tone
What drives function in a denervated heart?
Frank-Starling mechanism
What’s unique about bicaval transplants?
Entire atrium removed, ventricular ectopy, bradycardia, pacemaker
What’s unique about biatrial transplants?
2 P waves, conduction blocks, A-fib
What is the diagnostic mPAP threshold for pulmonary hypertension?
Mean pulmonary artery pressure (mPAP) > 25 mmHg at rest
What is the gold standard diagnostic tool for pulmonary hypertension?
Right heart catheterization
How many types of pulmonary hypertension are there?
5 different types
What test helps assess the severity of pulmonary hypertension?
6-minute walk test
What distance on the 6-minute walk test indicates increased disease and risk?
<600 meters
What should be done with elective surgery in patients with pulmonary hypertension?
Postpone elective surgery
What are key anesthesia considerations for a patient with pulmonary hypertension?
Avoid hypotension, have a solid anesthesia plan, and continue all medications
What are common causes of peripheral artery disease (PAD)?
Smoking, diabetes, HTN, sleep apnea, autoimmune diseases
What is the primary pathology behind PAD?
Atherosclerosis
Which organs are affected by systemic atherosclerosis in PAD?
Kidney, liver, heart, cerebral
What should be included in the physical exam for PAD?
Pulses, bruits, BP, systemic organ evaluation
What preoperative conditions should be managed in patients with PAD?
CAD, heart failure, rhythm disturbances
What components make up a typical CIED?
Pulse generator + 1 to 3 leads
What types of new pacemaker technologies are being developed?
Leadless and coilless pacemakers and defibrillators
What are the two main types of cardiac implantable devices?
ICD and Pacemaker
What imaging tool helps distinguish between ICD and pacemaker?
Chest X-ray
Where can pacemaker leads be inserted?
RA, RV, coronary sinus
What is the main function of an implanted cardioverter defibrillator (ICD)?
Prevention of sudden cardiac death
What does Position I of the CIED code represent?
Chamber(s) paced (O=None, A=Atrium, V=Ventricle, D=Dual A+V)
What does Position II of the CIED code represent?
Chamber(s) sensed (O=None, A=Atrium, V=Ventricle, D=Dual A+V)
What does Position III of the CIED code represent?
Response to sensing (O=None, T=Triggered, I=Inhibited, D=Dual T+I)
What does Position IV of the CIED code represent?
Rate modulation (O=None, R=Rate modulation)
What does Position V of the CIED code represent?
Multisite pacing (O=None, A=Atrium, V=Ventricle, D=Dual A+V)
Which type of cautery can interfere with an ICD during surgery?
Monopolar cautery
Which type of cautery has minimal effect on ICDs?
Bipolar cautery
Why is cutting above the umbilicus concerning in patients with CIEDs?
It can significantly impact the device
Which devices should be used cautiously with CIEDs during surgery?
Nerve/block stimulators, saws, high-vibration tools
What is commonly done to CIEDs during surgery?
Disable the unit
What is the pacemaker’s typical response to a magnet?
Initiates asynchronous pacing
What happens to defibrillators when a magnet is placed over them?
They are usually deactivated while the magnet stays in place
