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Advanced Exam > Cardiac > Flashcards

Cardiac Flashcards

1
Q

PCWP tracing change with papillary muscle rupture

A

Large V-waves

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

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2
Q

PCWP Large A waves cause?

A

Mitral stenosis

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3
Q

Cannon A waves cause?

A

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

Looks like there is no c-wave

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4
Q

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

A

Disables ICD

No effect on pacemaker

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5
Q

1 congenital anomaly at birth?

A

Perimembranous VSD

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6
Q

CVP waveform for pericardial tamponade

A

Exaggerated X-descent

Small y-descent

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7
Q

CVP waveform for constrictive pericarditis

A

Exaggerated X and Y-descent

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8
Q

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

A

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)

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9
Q

EKG abnormality with hypoCa

A

Prolonged QT

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10
Q

pH stat monitoring

A

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

can have inc cerebral embolic load and worse cognitive function

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11
Q

Tx goals for MR

A

Fast, full, forward

afterload reduction + slight inc HR + maintain preload

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12
Q

Electrolyte abnormalities causing prolonged PR

A

hyPeR - K, Ca, Mag

Tends to cause shortened QT (opposite of PR)

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13
Q

Injectate volume and temp that overestimates CO

A

Lower volume

Inc temp 1deg = 3%

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14
Q

Causes of high MvO2

A 
Low O2 consumption
Cyanide
CO
Hypothermia
High CO states (sepsis, burn, pancreatitis)
L-R shunt
Ionotropes
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15
Q

Pulse pressure effect further from the heart

A

Pulse pressure is inc

Systolic pressure higher

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16
Q

Causes of Inc pulse pressure

A 
Hyperthyroidism 
Ai
Peripheral vasodilation 
Avms
Mild hypovolemia
17
Q

Narrow pulse pressure causes

A 
Hypovolemia 
Tamponade 
CHF
AS
Shock
18
Q

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

A

Right coronary cusp

- located right next to the RV

19
Q

How does hypothermia affect gas solubility?

A

Inc solubility —> dec partial pressures

Heating —> dec solubility and falsely elevates partial pressures

20
Q

How does temp affect blood pH?

A

pH rises 0.015 for every 1 degree decrease in temp

21
Q

What accounts for pulsus paradoxus?

A

Shift of interventricular septum

22
Q

Tx desaturation with Fontan physiology

A

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

23
Q

Tx desaturation in unrepaired TOF or w/ BT shunt

A

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

24
Q

Indications for retrograde cardioplegia

A

AI
Prior IMA graft
Prolonged valve or root repairs

25
Q

Best way to augment BP following heart transplant

A

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.

26
Q

Pacemaker mode for persistent fib and bradycardia

A

DDDR

27
Q

Formula for PVR

A

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

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

28
Q

Formula for SVR

A

[(MAP - CVP)/ CO] x80

Normal = 700-1600

29
Q

What is the R function in pacemakers?

A

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

30
Q

Med contraindicated in Long QT syndrome

A

amiodarone

  • prolongs repolarization
  • blocks both cardiac K and Ca channels
  • Dec SVR
31
Q

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

A

Ca = verapamil CCB blocks nodes

32
Q

Bainbridge reflex

A

Inc right heart stretch and pressure = increase HR

33
Q

Bezold-Jarisch reflex

A

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

34
Q

Tx stable Afib w/ RVR with impaired LV function

A

Amiodarone

35
Q

Tx for WPW with narrow complex tachycardia

A

Adenosine

If unstable, cardioversion first

36
Q

Tx for WPW with regular wide complex tachycardia

A

Procainamide 10mg/kg over 10 min

37
Q

Tx of WPW with AF (irregularly irregular) tachycardia

A

Amiodarone 150mg load

Advanced Exam (10 decks)

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