Cardiac abnormalities Flashcards
QTc is prolonged if it exceeds ___ in men or ____ in women
440 ms, 460 ms
_____ administration can speed conduction of cardiac impulses through the AV node. When would this be useful?
Atropine. 1st degree heart block
_______ is more likely to progress to third-degree block, especially in the setting of acute MI
Mobitz Type II
Which second-degree block is usually symptomatic?
type II
Tx of third-degree AV block occurring during anesthesia
transcutaneous or transvenous pacing
a cardiac rhythm greater than ___ is considered a tachydysrhythmia
100 bmp
tachydysrhythmia with average HR 160-220 bmp
Paroxysmal supraventricular tachycardia
How does multifocal atrial tachycardia differ from a fib? What is the usual rate?
rate is not excessively rapid & each QRS is a/w a P wave; 100-180 bmp
What should you do if new-onset a fib occurs before induction?
postpone sx if possible until ventricular rate is controlled or conversion to SR
Characterized by an organized atrial rhythm with an atrial rate of 250-350 bpm with varying degrees of AV block
atrial flutter
What should you do if a pt has atrial flutter lasting longer than 48 hrs
anticoagulant therapy
The purpose of cardioversion is to recoordinate the electrical pathways of the heart by delivering a single dominant burst of electricity where?
on the R wave of the ECG
Where are the leads in a dual chamber pacemaker?
1 in R atrium, 1 in R ventricle
uncontrolled BP despite 3 or more antihypertensive drugs of different classes
resistant HTN
uncontrolled BP on 5 or more drugs
Refractory HTN
First-line antihypertensive therapy
diuretics, CCBs, ACE inhibitors, & ARBS (NOT BBs)
Delaying surgery is not generally recommended unless there is marked HTN of ____
systolic > 180, diastolic > 110
How do you get diagnosis of pulmonary HTN?
right heart cath
Most common cause of right heart failure
left sided failure
How is orthopnea relieved?
sitting up
Tx for systolic HF
ACE inhibitors &Beta Blockers
Best tx strategy for diastolic heart failure
prevention
What are 3 anesthetic considerations for VADs
anticoagulation, plug device into an electrical outlet, & avoid chest compressions
What is used as a substitute for pulse oximetry with VADs?
cerebral oximeter that does not rely on pulsatile flow
The balloon pump ______ in diastole, and _____ in systole
inflates; deflates
Optimal functioning of the TandemHeart depends on what?
good RV function
The most common cause of restrictive CM
amyloidosis
What do you not want to see with restrictive CM?
bradycardia
Oxygen supplementation to maintain the PaO2 above ___ and sat above ___ is useful in both acute and long-term tx of RHF
60mmHg, 90%
a heart murmur that occurs during systole is d/t what?
stenosis of the aortic or pulmonic valves
When is prophylactic abs recommended?
dental procedures and invasive procedures involving the respiratory tract
What is the normal mitral valve orifice?
4-6 cm
An opening snap is a/w mitral ________ while a holosystolic murmur is a/w mitral _______.
stenosis; regurgitation
What is the normal aortic valve area?
2.5-3.5 cm
What drug is given to close the PDA?
indomethacin (cyclooxygenase inhibitor)
What is the classic presentation tetralogy of fallot?
hypercyanotic spell “TET spell” cyanosis, hyperapnea, possible loss of consciousness etc
How can you prevent TET spells?
avoid stressful situations & premedicate to prevent catecholamine release that triggers infundibular spasms
When does acute pericarditis commonly appear?
1-3 days following a transmural MI
What is Beck,s triad and when is it observed?
distant heart sounds, increased jugular venous pressure, & hypotension;
observed in 1/3 of pts w/ acute cardiac tamponade
BP monitoring must be via an artery in the ___ arm since occlusion of the aorta can prevent measurement of BP in the ____ arm
right; left
