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Clinical Methods > Cardiac Disorders and 12 Lead EKG Part 3 > Flashcards

Cardiac Disorders and 12 Lead EKG Part 3 Flashcards

1
Q

What disease is characterized by a blowing murmur heard best along the left sternal border plus peripheral signs of hyperdynamic circulation (widened pulse pressure,decreased diastolic pressure, and bounding peripheral pulses)?

A

aortic regurgitation

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2
Q

What tests confirm severity of aortic regurgitation? (3)

A
  • Echo
  • Cardiac catheterization
  • CXR & ECG: provides evidence of LV enlargement
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3
Q

Symptoms of aortic regurgitation appear early on. True or false?

A

false

appear in advanced stages

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4
Q

Medical therapy of aortic regurgitation is based on decreasing left ventricle afterload by drug induced vasodilation with ______ for acute LV overload and ________ for asymptomatic patients.

A

nitroprusside

nifedipine

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5
Q

Anesthetic considerations for aortic regurgitation: (3)

A
  • avoid sudden decreases in HR
  • avoid sudden increases in SVR
  • minimize drug-induced myocardial depression
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6
Q

What disease is usually functional, reflecting dilation of the right ventricle due to pulmonary HTN?

A

tricuspid regurgitation

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7
Q

What also accompanies tricuspid regurgitation? (2)

A
  • pulmonary HTN
  • RV volume overload due to LV failure produced by aortic or mitral valve disease
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8
Q

What heart disease is secondary to infective endocarditis and also associated with IV drug abuse?

A

tricuspid regurgitation

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9
Q

Tricuspid regurgitation is also associated with _____ _____ when valve dysfunction is the result of prior rheumatic fever.

A

tricuspid stenosis

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10
Q

Consequence is RA volume overload is usually well tolerated, but when paired with RV volume overload from LV failure or pulmonary HTN, this can lead to ___ ____ failure which can cause ___ atrium pressure to be greater than ___ atrium pressure resulting in left-to-right intracardiac shunt through an incompletely closed foramen ovale.

A

right ventricle

right

left

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11
Q

Anesthetic consideration for tricuspid regurgitation: (5)

A
  • maintain IV volume
  • maintain central venous pressures in high normal ranges to facilitate adequate RV stroke volume and left ventricular filling
  • avoid events that increase PVR (arterial hypoxemia and hypercarbia)
  • consider Ketamine since no vasodilation occurs
  • avoid IV infusion of air due to possibility of right-to-left intracardiac shunt through an incompletely closed foramen ovale
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12
Q

What condition is this?

BP > 140/90 on at least 2 occasions measured at least 1-2 weeks apart

A

systemic hypertension

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13
Q

The following conditions can develop as a result of ____ ______.

  • ischemic heart disease
  • congestive heart failure
  • cerebral vascular accident
  • arterial aneurysm
  • end stage renal disease
A

systemic hypertension

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14
Q

Optimal BP is: ____/_____

Normal BP is less than ____/____

A

120/80

130/85

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15
Q

High-normal BP ranges from:

Systolic: ___ - _____

Diastolic: ____ - _____

A

130-139

85-89

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16
Q

Stage 1 Hypertension ranges from:

Systolic: ____-____

Diastolic: _____-____

A

140 - 159

90 -99

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17
Q

Stage 2 Hypertension ranges from:

Systolic: ____-____

Diastolic: _____-____

A

160 - 179

100 - 109

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18
Q

Stage 3 Hypertension BP is ___ / ___

A

180

110

19
Q

What accounts for 95% of all cases of HTN?

A

Essential HTN

20
Q

The cause of ____ HTN cannot be identified.

A

essential

21
Q

Familiar incidence and patholphysiological factors such as:

  • increased sympathetic NS activity
  • overproduction of Na retaining hormones & vasoconstrictors
  • high Na intake
  • increased renin secretion
  • deficiencies of vasodilators

describe ______ hypertension.

A

essential

22
Q

Known etilogy is present in _____ HTN.

A

secondary

23
Q

What is the most common secondary type of HTN?

A

Renovascular HTN from renal artery stenosis

24
Q

When renovascular HTN is present, diastolic BP is usually > ____ mmHg and an ____ ____ ___ is present.

A

125

upper abdominal bruit

25
Q

What test confirms secondary HTN?

A

MRI

26
Q

What is the treatment of essential HTN?

A
  • lifestyle modification: weight reduction, increase in physical activity, moderation in alcohol, quit smoking
  • pharmacologic therapy: diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers
  • calcium channel blockers
27
Q

Secondary HTN is treated by: (2)

A
  • treatment is often surgical (angioplasty, surgery for stenotic renal artery, adrenalectomy)
  • pharmacologic therapy reserved for patients in those where surgery is not possible
28
Q

Hypertensive crisis when acute diastolic BP > _____mmHg.

A

130

29
Q

Need for emergent treatment determined by absolute BP rather than rate of increase. True or false?

A

False,

determined by rate of increase rather than absolute BP

30
Q

Patients with evidence of acute or ongoing target organ damage (encephalopathy, CHF, renal insufficiency, subarachnoid hemmorage) require prompt treatment with ____ BP lowering agents.

A

IV

31
Q

Don’t decrease BP to normotensive levels!

Desired decrease is MAP < ___% in first 2 hours, then additional decreases over next ___-___ hours.

A

20

24-48

32
Q

Meds to consider delivering during hypertensive crisis: (3)

A
  • Nitroprusside
  • Hydralazine
  • Nitroglycerine
33
Q

Anesthetic considerations for HTN during preop evaluation: (3)

A
  • determine adequacy of BP control
  • review drugs being administered for BP control
  • evaluate evidence of end-organ damage
34
Q

For HTN patients: induction of anesthesia considerations: (2)

A
  • anticipate exaggerated BP changes
  • limit duration of DL
35
Q

For HTN patients: maintenance of anesthesia considerations: (2)

A
  • administer a volatile anesthetic to blunt HTN responses
  • monitor for MI
36
Q

For HTN patients: post-op management considerations (2)

A
  • anticipate periods of HTN
  • maintain monitoring of end-organ function
37
Q

Condition occurs when the heart is unable to provide sufficient pump action to distribute blood flow to perfuse tissues and organs of the body.

A

Congestive heart failure

38
Q

What are the causes of CHF? (4)

A
  • valve abnormalities
  • impaired contractility secondary to ischemic heart disease or cardiomyopathy
  • systemic HTN
  • pulmonary HTN (cor pulmonale)
39
Q

What is the most common form of heart failure?

Fluid may back up in the lungs causing SOB.

A

left-sided heart failure

40
Q

What most commonly results from left-sided heart-failure?

A

right-sided heart failure

41
Q

Fluid may back up into the abdomen (ascites) and legs and feet (edema) in this type of heart failure.

A

right-sided heart failure

42
Q

In this type of heart failure, the left ventricle cannot contract vigorously, indicating a pumping problem.

EF < ___% in this case.

A

systolic

45

43
Q

In this type of heart failure, the left bentricle cannot relax or fill fully, indicating a filling problem from noncompliant ventricles.

A

diastolic heart failure

Clinical Methods (23 decks)

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