CARDIAC ANESTHESIA and BOOM!

Question 1

The anesthetic GOAL for Hypertrophic Cardiomyopathy are:

Answer 1

Increase PRELOAD and AFTERLOAD
Decrease HEART RATE and CONTRACTILITY

Therefore Brady but Big LOADS!

Question 2

Is it SAFE to do NEURAXIAL Anesthesia to a HYPERTROPHIC CARDIOMYOPATHY patient?

Answer 2

YES. Epidural is preferred to maintain preload and afterload. Normotension should be made and if possible, avoid EPINEPHRINE.

PHENYLEPHRINE is favored over Epinephrine, Norepi or Ephedrine as it results in a more favorable hemodynamics. Increase Afterload, Decrease HR, no Inotropy!

Question 3

Which part of the cardiac bypass surgery wherein STEMI most likely to occur?

Answer 3

WEANING FROM BYPASS due to disruption of the coronary blood flow

Question 4

Vasopressor agent of choice for AORTIC STENOSIS

Answer 4

Phenylephrine

Question 5

How does acute mitral regurgitation affect the afterload?

A. Increased
B. Decreased

Answer 5

Decreased

Mitral regurgitation decreases AFTERLOAD due to extra outlet back into the left atrium.

Question 6

The dicrotic notch is missing on an arterial waveform. This is seen in which valvular lesion:

A. Aortic stenosis
B. Aortic regurgitation

Answer 6

A. Aortic stenosis

missing dicrotic notch > Aortic Stenosis

Question 7

On an arterial pressure waveform, Aortic Regurgitation is characterized by:

A. Low diastolic pressure and sharp upstroke
B. High systolic pressure and sharp upstroke
C. High diastolic pressure and sharp upstroke

Answer 7

A. Low diastolic pressure and sharp upstroke

Question 8

Hemodynamic goal for a patient with AORTIC STENOSIS?

A. Decrease in preload
B. Decrease in afterload
C. Normal Heart Rate
D. Increase Heart Rate

Answer 8

C. Normal Heart Rate

Question 9

Hemodynamic goal for a patient with MITRAL STENOSIS?

A. Increase Heart Rate

B. Slight Hypervolemia

C. Maintain Preload

D. Decrease Preload

Answer 9

C. Maintain Preload

Patients with MS are at risk for developing pulmonary edema and RV failure.

Tachyarrhythmias, hypervolemia, and preventing further increases in right ventricular afterload should be avoided.

Question 10

Valvular regurgitation causes:

A. Volume overload
B. Pressure overload

Answer 10

A. Volume overload

VOLUME OVERLOAD > Eccentric hypertrophy > Regurgitation

Question 11

Valvular Stenosis causes:

A. Volume overload
B. Pressure overload

Answer 11

B. Pressure overload

PRESSURE OVERLOAD > Concentric hypertrophy > Stenosis