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Specialty Exams > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Calculation for anion gap

A

(Na + K) - (Cl + HCO3)

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2
Q

Metabolic acidosis is defined by….

A

A decrease in HCO3

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3
Q

Respiratory acidosis is defined by…

A

Increase in CO2

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4
Q

What is pericardial tamponade

A

Filling of the pericardial sac with fluid

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5
Q

Signs of cardiac tamponade

A
  • Narrow pulse pressure
  • Elevated CVP
  • Distant heart sounds
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6
Q

Hemodynamic goals when managing a patient with mitral or aortic regurgitation

A
  • Keep SVR low to maintain forward flow and decrease regurgitant fraction
  • High normal HR to decrease time in diastole and decrease regurgitant fraction
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7
Q

Pharmacologic support during cardiac tamponade

A

Increase HR and contractility to maintain cardiac output

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8
Q

What is pulseless electrical activity

A

An EKG rhythm that should produce a pulse but does not

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9
Q

Treatment for pulseless electrical activity

A

CPR, defibrillation, epi

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10
Q

Signs of right heart failure

A
  • Peripheral edema
  • Hepatomegaly
  • Coagulopathy
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11
Q

Signs of left ventricular failure

A
  • Dizziness
  • Pulmonary edema
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Coughing
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12
Q

A silent MI is associated with what disease

A

Diabetes

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13
Q

Atrial kick is responsible for what percentage of stroke volume

A

20-30%

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14
Q

What is dromotropy

A

Rate of AV node conduction

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15
Q

What is lusitropy

A

Rate of cardiac relaxation

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16
Q

What is NOT a good indicator of volume status in a renal patient?

A

Urine output

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17
Q

Factors affecting myocardial oxygen consumption

A
  • Heart rate
  • Contractility
  • Preload
  • Afterload
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18
Q

Myocardial oxygen extraction

A

Myocardium extracts 65% of oxygen in arterial blood

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19
Q

Equation for SVR

A

80*(MAP-CVP) / CO

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20
Q

Normal values for SVR

A

700-1600 dynes

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21
Q

Equation for PVR

A

80*(PAP-PCWP) / CO

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22
Q

Normal values for PVR

A

20-130 dynes

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23
Q

ACLS dose for vasopressin

A

40 units

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24
Q

Treatment of asystole after chest closure following AVR

A

Chest compressions

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25
Q

Treatment of ventricular fibrillation

A
  • Defibrillation
  • 1mg epi
  • 300mg amiodarone
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26
Q

Treatment of ventricular tachycardia

A
  • 300mg amiodarone

- 1mg/kg lidocaine

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27
Q

Anesthetic management for cardiomyopathy

A

Treat hemodynamics with beta blockers and calcium channel blockers - NO INOTROPES

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28
Q

Anesthetic techniques for patients with pulmonary hypertension

A
  • Nitric oxide therapy
  • PEEP
  • Hyperventilation
  • Correct acidosis
  • Deepen anesthetic
  • Milrinone
  • Avoid N2O because it increases PVR
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29
Q

Perioperative management of AICD

A
  • Interrogate defibrillator
  • Contact manufacturer
  • Disable AICD
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30
Q

Indications for IABP

A

Inability to come off bypass with inotropes and pressors

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31
Q

Contraindications to IABP placement

A
  • Aortic insufficiency

- Aortic dissection

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32
Q

Delay of elective, noncardiac surgery following an acute MI

A

30 days

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33
Q

Preparation for redo sternotomy

A
  • R2 pads

- Type and crossed units of blood available in the room

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34
Q

Drugs and conditions to avoid in obstructive hypertrophic cardiomyopathy

A
  • PDIs

- Inotropes

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35
Q

Management of obstructive hypertrophic cardiomyopathy

A
  • Treat with beta blockers and CCBs
  • Alpha agents good for blood pressure treatment
  • Avoid hypovolemia
  • Avoid sympathetic stimulation (beta 1)
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36
Q

Clinical findings in cardiomyopathy

A
  • SOB
  • Angina
  • Dyspnea
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37
Q

Pathophysiology of obstructive hypertrophic cardiomyopathy

A

Dynamic obstruction of LV outflow during systole

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38
Q

Treatment of hypotension in obstructive hypertrophic cardiomyopathy

A

A1 agonist

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39
Q

Anesthetic management during CPB is the responsibility of…

A

The perfusionist

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40
Q

Anesthetist’s responsibility during CPB

A
  • Background pressors
  • Urine output
  • Monitor MAPs
  • Monitor bladder temp
  • Running TXA
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41
Q

Carbon dioxide use during hypothermic CPB

A

Sprayed in an open vessel to avoid air embolism

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42
Q

Dose of heparin for CPB

A

400units/kg

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43
Q

MAP goal during CPB

A

60-80mmHg

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44
Q

Minimum ACT needed to initiate CPB

A

400

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45
Q

Normal blood flow rate for adult on total CPB

A

4-5L/min

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46
Q

How much is oxygen consumption decreased during cooling on CPB

A

7% per degree celsius

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47
Q

Where is cardioplegia injected during retrograde cardioplegia

A

Coronary sinus

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48
Q

Heart sounds associated with mitral valve prolapse

A

Mid systolic click

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49
Q

Assessing heparinization during CPB

A

ACT is taken every 30 minutes

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50
Q

Blood product used to increase fibrinogen

A

Cryo

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51
Q

Antithrombin III deficiency and hepariniztion

A

Heparin increases the activity of ATIII so if the patient is deficient the heparin will not work efficiently

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52
Q

Elimination half life of heparin

A

1.5 hours

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53
Q

Management of hypofibrinogenemia

A

Give cryo

54
Q

Normal range for ACT

A

80-120

55
Q

Morbidity and mortality for off-pump CABG

A

10% morbidity, 2.3% mortality

56
Q

Morbidity and mortality for on-pump CABG

A

14% morbidity, 2.9% mortality

57
Q

Acute and long term management for CHF

A

Acute - vasodilators, diuretics, PPV

Long term - ACE inhibitors, diuretics, beta blockers, AICD, heart transplant

58
Q

Pathophysiology of heart failure

A

Hypertrophy of the ventricle leading to an increased stiffness

59
Q

Oxygen demand breakdown of myocardium

A

64% pressure work
20% basal
15% volume work
1% electrical activity

60
Q

Etiology of left lateral wall infarction

A

Circumflex

61
Q

Etiology of anterior wall infarction

A

LAD

62
Q

Etiology of inferior wall infarction

A

Right coronary

63
Q

Etiology of posterior wall infarction

A

Right coronary

64
Q

Most sensitive monitor for left ventricular ischemia

A

EKG - Leads II, V4, V5

65
Q

Risk factors for ischemic heart disease

A
  • Hyperlipidemia
  • HTN
  • Smoking
  • High BMI
66
Q

Infusion rate of norepinephrine

A

4-12mcg/min (0.05mcg/kg/min)

67
Q

Infusion rate of epinephrine

A

4-12mcg/min

68
Q

Infusion rate of milrinone

A

0.375-0.75mcg/kg/min

69
Q

Infusion rate of vasopressin

A

2-8 units/hr

70
Q

Infusion rate of phenylephrine

A

25-100mcg/min (0.1-1mcg/kg/min)

71
Q

Infusion rate of NTG

A

0.5-10mcg/kg/min

72
Q

Infusion rate of NTP

A

0.5-10mcg/kg/min

73
Q

Infusion rate of nicardipine

A

5mg/hour

74
Q

Infusion rate of insulin

A

2-6units/hr

75
Q

Infusion rate of fentanyl

A

0.5-5mcg/kg/hour

76
Q

Infusion rate of esmolol

A

50-300mcg/kg/min

77
Q

Cardiac drugs without inotropic effects

A
  • Phenylephrine

- Vasopressin

78
Q

Management of vtach when lidocaine fails

A

300mg amiodarone

79
Q

Drug treatment of RV failure secondary to high PVR

A

Milrinone

80
Q

Drug treatment of myocardial ischemia

A

NTG

81
Q

Contraindications of TEE

A
  • Surgery on stomach/esophagus

- Esophageal stricture/spasm/laceration/perforation/diverticula

82
Q

Indications for intra-operative TEE

A
  • Suspected embolism
  • Infective endocarditis
  • Valvular heart disease
  • Detection of intracardial mass
  • Congenital heart disease
  • Ischemic heart disease
83
Q

Calculation of cardiac index

A

CO/BSA

84
Q

Calculation of stroke volume

A

EDV-ESV

85
Q

Myocardial dysfunction with hypocalcemia

A
  • Hypokinesia

- Prolonged QT

86
Q

Absence of A wave on CVP tracing is indicative of

A

A fib

87
Q

ECG lead that detects left ventricular ischemia

A

V5

88
Q

Symptom of myocardial ischemia

A

Jaw pain

89
Q

Management of vtach when shock therapy fails

A

Amiodarone

90
Q

Effect of desflurane on PVR

A

increases

91
Q

Normal lactate

A

0.5-2.2mmol/L

92
Q

Normal calcium levels

A

1.19-1.33mmol/L

93
Q

Normal magnesium levels

A

0.7-1mmol/L

94
Q

Trans valvular gradient in critical aortic stenosis

A

Greater than 50mmhg

95
Q

Probable cause of death in untreated pulmonary hypertension

A

Right ventricle failure

96
Q

Treatments for acute pulmonary hypertension

A

Increase FiO2, hyperventilation, adequate analgesia, nitric oxide, prostaglandin

97
Q

Factors that increase PVR

A

Hypoxia, hypercarbia, acidosis, pain, N2O

98
Q

Etiology of anterior MI

A

Left main occlusion

99
Q

Major risk factor for complications during CABG

A

CHF

100
Q

Transfusion trigger for PRBCs

A

Hgb of 7 or Hct under 21

101
Q

Transfusion trigger for platelets

A

Platelets under 100K

102
Q

Treatment for decreased factors 8, 12, and vWF

A

Desmopressin 0.3mcg/kg

103
Q

Treatment for decreased coagulation factors

A

FFP

104
Q

Issue associated with massive transfusion of PRBCs

A

Hypocalcemia and citrate toxicity

105
Q

Determination of preload with an ECHO

A

Assess LVEDV via LV EDA using transgastric short axis view

106
Q

What lab should be checked in the case of a persistent AV block following CPB

A

K+, if high treat with calcium, nahco3, lasix, or glucose + insulin

107
Q

Interpretation of peaked T waves following CPB

A

Hyperkalemia

108
Q

Interpretation of prolonged QT interval following CPB

A

Hypocalcemia

109
Q

Interpretation of irregular rhythms following CPB

A

Hypomagnesium

110
Q

Normal range for Cl-

A

110-110

111
Q

Treatment for postop shivering

A

25mg meperidine

112
Q

Mortality with untreated pulmonary hypertension

A

30% within 3 years

113
Q

Method of administering platelets

A

Room temperature 150 micron filter

114
Q

Transfusions are indicated for cardiac surgery when the Hgb is below

A

7

115
Q

Transfusions are indicated for cardiac surgery when the Hct is below

A

21

116
Q

Transvalvular gradient in critical aortic stenosis

A

Over 50mmHg

117
Q

Management of Vtach when shock therapy fails

A

Amiodarone

118
Q

Effect of Des on PVR

A

Increases

119
Q

Normal lactate values

A

0.5-2.2 mmol/L

120
Q

Normal calcium levels

A

1.2-1.3 mmol/L

121
Q

Normal magnesium levels

A

0.7-1 mmol/L

122
Q

Electrolyte imbalance that is possible after transfusing a lot of PRBCs

A

Hypocalcemia bc the calcium binds to the citrate in the packed rbcs

123
Q

Non-anion gap metabolic acidosis is associated with what electrolyte imbalance

A

Hyperchloremia

124
Q

Core body temp must be at least __ degrees celsius before separating from CPB

A

37

125
Q

Requirements for coming off pump

A
  • Normal core temp
  • Hgb at appropriate level
  • Normal HR/rhythm
  • 100% FiO2
126
Q

When performing TEE, how do you determine preload

A

LVEDV

127
Q

Old man comes off bypass but wont stop bleeding. Platelets are 150k and fibrinogen is 80. What should your initial treatment be?

A

Cryo

128
Q

Most dangerous patient risk factor when undergoing CABG

A

CHF

129
Q

Highest morbidity and mortality in CABG is concomitant with what comorbidity

A

CHF

130
Q

If a patient has diastolic dysfunction they will most likely have a reduction in what volume

A

Stroke volume

131
Q

Common symptom of myocardial ischemia

A

Jaw pain

132
Q

Probable cause of death with untreated pulmonary hypertension

A

Right heart failure

Specialty Exams (1 decks)

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