Cardiac Flashcards
Concentric vs eccentric hypertrophy
Con-seen with LVH and HTN from pressure overload
Eccentric-seen with volume overload
Diuretics can cause which electrolyte derangements?
Decreased K, Mg, NA.
Increased glucose, Urate, lipid, and possibly increased K
Probs with Calcium channel blockers:
Can cause heart block, myocardial depression, potentiation of NMB, peripheral edema and reflex tachycardia (nifedipine)
Pre-op assessment for HTN: Look for signs of CHF when you see HTN? What else to look for-labs, imaging, ECG?
Yes look for CHF signs.
BUN/Cr for rental involvement, Na/K for diuretic effects, ECG for LVH, CXR for cardiomegaly and pulmonary edema
Pre-medication in a pt with HTN:
BP neds?
Sedation and anxiolytics are often good
Acute control with beta blockers can be helpful
Where from baseline should BP be kept?
Within 20% unless it is markedly elevated
Anesthetic significance of HTN
CV, Renal, Neuro. Causes if HTN:
Hemodynamics profile-HTN-early va late and how it relates to CO and SVR
LVH, diastolic dysfunction, vasopressin sensitivity, increased risk of MI, CHF, Aortic dissection
Rental-overactivity of RASS system and nephropathy
Neuro-potential increase risk of stroke and right shift of auto regulation curve
Causes: essential, followed by renal, endocrine-hyperaldosteronidm, Cushing’s, costctstion, drug side effects (estrogen)
HTN early vs late-early increased CO with normal SVR. Later-increase in SVR without Co
Cancel the case at which BP? A line for everyone?
There is no absolute cutoff. Emergency-would proceed no matter what the BP. It depends on the cause of HTN, chronic ott, symptomatomogy, difficulty with it being controlled, co-existing disease and type of surgery to be performed.
Best induction technique for OT with HTN?
No absolute beat technique, but a good one would include avoiding precipitous drops in BP from a rapid induction, achieve a deep level of anesthesia prior to laryngoscopes and intubation, and avoid vasopressors
HTN with a full stomach?
HTN with full stomach-need to analyze which risk is greater-aspiration or BP lability on induction. Elective-wait, had to proceed and aspiration risk low-proceed with slow induction.
High aspiration risk-a line prior to induction, RSI with etomidate and sux
Difficult airway, full stomach, HTN
Airway first-needs to be spontaneously breathing:
Supplemental O2, sedation!!, a line, topicalize airway with aerosolized 2%lidocaine, topicalize nasal mucosa with lidocaine jelly and phenylephrine. Glossopharyngeal, superior laryngeal, trans trachea blocks
How to do a glossopharyngeal, superior laryngeal, and tramstracheal block:
Hug
Automatically use etomidate?
No. In the normal, euvokemic, or HTN patient, it is not as reliable in preventing HTN with laryngoscopy and intubation
Ketamine in HTN patients-is it contraindicated?
It may cause more tachycardia and HTN, but no contraindicated especially if it currently hypotension or hypovolemic. Catecholamine depletion would unmask the direct myocardial depressant effect of ketamine, but the patient would still be spontaneously breathing
After surgery, your hypertensive patient is HTN in PACU-what to do?
Make sure HTN is real
ABCs-hypoxia and hypercarbia can cause sympathetic stimulation
Limb leads:
Criteria of ischemia on EKG:
Oscillometry concept:
Limb-1,2,3
1 mm ST depression, or 2 mm ST elevation
Oscillometry-cuff inflates to Supra systolic pressures and deflated in increments. Arterial pulsations are measurable oscillations in pressure
