Cardiac Keywords Flashcards by Joseph Edward

When viewed on a chest x-ray the correct position of the tip of a CVL via the RIJ is

Above the level of the carina

Too high vessel erosion

Too low 11th pericardial reflection which is at the level of the Carina; arrhythmia,coronary sinus and TV damage

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Which walls of the LV Do you see on ME four chamber view?

Lateral wall and septum

Coronary sinus

This is where you place a retrograde cardioplegic catheter

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Which walls of the LV are visible on the ME to chamber view?

The anterior and inferior walls

LA appendage is also visible

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ME bicaval view

Which Chambers can you see

RA and LA

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What are you able to focus on on the ME RV inflow outflow view?

Aortic valve

The non-coronary cusp lies against the interatrial septum

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Which part of the heart does the Vegas nerve innervate

Which neurotransmitter does it use

The SA and AV node

Acetylcholine

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At which spinal levels are the cardio accelerator fibers found

T1 -T4

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Name the sympathetic ganglion in the neck abdomen and pelvis

Neck stellate ganglion
abdomen celiac plexus mesenteric and hypogastric’s
pelvis ganglion impar

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Are white ram I communications pre-or post ganglionic

Preganglionic containing Spinal nerves on their way to sympathetic ganglia

Gray rami are postganglionic fibers from the sympathetic to the spot on earth

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What is the pathway of the oculocardiac reflex

Afferent ciliary nerves to the ciliary ganglion on the gasserian ganglion to brainstem

Efferent via the vagal nerve

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Which wavelengths are preferable for penetration

Large wavelengths have better penetration while smaller wavelengths a better resolution

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I wonder what condition do you have increased stroke volume variation with respiration

With low preload

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IVC greater than 2cm and no resp variation

Elevated CVP

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What three factors affect SVO2 (mixed venous oxygen sat)

CO
VO2
CaO2 (oxygen content of arterial blood)

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What is a normal SVO2 measured at the tip of a PAC?

68-77% (PvO2 38-42 mmHg)

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Which disease states result in high SVO2 (Mixe venous O2 sat)?

Low O2 consumption: cyanide toxicity, hypothermia

High CO: sepsis, L-R shunt, AV fistula, liver disease

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Which disease states resulting in decreased mixed venous O2 sat?

Low Hb
Increase O2 consumption (fever, shivering)
Low SaO2 (hypoxia, ARDS)
Low CO (MI, CHF, hypovolemia)

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What is SVO2 and what does it reflect

Percent of oxygen bound to hemoglobin Returning to the right side of the heart
this reflects how much oxygen is left over by the tissues

Central venous/mixed venous

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How long do you delay surgery after a BMS vs a DES?

BMS: 30d

DES: 365d

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Under what circumstances would you discontinue a stent patients antiplatelet regimen?

Nonelective surgery

Risk of bleeding is higher than stent thrombosis

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When can elective non-cardiac surgery after DES be considered?

After 180 days

Your patient has a pacemaker and it has three positions for its nomenclature

What do these positions represent?

Paced sense response

O-none
A-atrium
V-ventricle
D-dual

Response to sensing:
O
T
I

O is none
T is triggered
I is inhibited
D is dual (both)

What is a magnet likely to convert a pacemaker to

VOO asynchronous

What does DOO mean?

Dual paced Senses nothing Responds to nothing

Is there Any evidence that anesthetic drugs alter stimulation threshold of pacemakers?

Which factors do alter pacemaker stimulation threshold?

Hyper and hypokalemia Arterial hypoxemia MI Catecholamines

Which drugs are acceptable to give in the trachea according to ACLS guidelines?

``` NAVEL Naloxone Atropine Vasopressin no longer indicated Epinephrine Lidocaine ```

What is Becks Triad

Hypotension JVD Distant heart sounds

What is Kussmals sign Pulsus paradoxus?

JVD with inspiration >10mmHg drop in SBP with inspiration

What is the anesthetic treatment of cardiac Tamponade?

Fast full tight hard ``` Keep full Avoid bradycardia Avoid high peak airway pressure Avoid decrease in SVR Maintain contractility Consider ketamine May need local for subxiphoid or CPB support via femoral ```

Name the two major outcomes of the POISE trial

Perioperative administration of PO to beta blocker naïve patient is associated with Decreased risk of non-fatal MI Increased risk of stroke and mortality

Name the major outcome of the JACC 2013 trial

Abrupt with drawl of beta blockers is harmful | Beta blockers should be continued on patients who have been on them

Why doesn’t NO dilate SVR?

NO binds to Hb forming nitrosylmethemoglobin therefore it does not dilate SVR

What are the effects and toxicity of nitrosylmethemoglobin?

Rapidly metabolized to methemoglobin Immunosuppression Inhibits platelet Adhesion and aggregation Rebound effect if discontinued causing increased PVR

How does nitrogen oxide work?

cGMP mediated Improved V/Q because it selectively goes to well ventilated alveoli Selectively dilated PVR Plum HTN and RV failure

Three symptoms of carcinoid syndrome What is the treatment Name a medication that can exacerbate

Flushing diarrhea and bronchoconstriction Octreotide histamine blockers and ipatropium Beta blockers

What is the effect of carcinoid syndrome on the heart

Serotonin induced fibrosis of valvular endocardium Restrictive cardiomyopathy Right sided valves TIPS tricuspid insufficiency pulmonary stenosis

Absolute indications to one lung ventilation

Protective isolation to prevent contamination or spread of abscess or hemorrhage Control of ventilation to one lung under circumstances like cutaneous fistula, cyst, or trauma Lavage VATS

Protamine is given and the patient has a catastrophic rxn. What are the two possible ways this can manifest? How would you treat the pt?

Anaphylaxis Catastrophic pulmonary hypertension Volume, epi, pulmonary vasodilator, antihistamine steroids

How does adranergic simulation affect the risk of developing torsades in patients with prolonged qt

Increases risk, continue perioperative beta blockers Correct k or mg

Vasopressin MOA

Nonadrenergic V1 receptor Systemic vasoconstriction, less effect on PVR than epi and norepi No longer indicated in ACLS

Compare the efficacy of vasopressin versus epinephrine in the following types of cardiac arrest: Vfib PEA Asystole

It is similar in the management of vfib and PEA it was found superior to epi in patients with asystole Study on Out of hospital cardiac arrest in 1200 patients, 2004 NEJM

Tx of choice in ACE/ARB periop hypotension

Vasopressin Efficacious even in acidosis

Which drugs are used for controlled hypotension?

NTP (nitroprusside) cGMP/NO releasing, dilates arterioles more than venues NTG dilates venules(capacitance) more than aa Alpha blockade (phentolamine, tolazoline, prazocin, doxazosin Nicardipine

What is the pathophysiology behind cyanide toxicity?

Inactivates cytochrome oxidase which stops oxidative phosphorylation therefore tissues cannot use O2 Commonly seen in high dose nitroprusside infusion and enclosed fires because of plastic inhalation

Patient on NTP presents with tachyphylaxis metabolic acidosis increased lactate and increased MVO2 What is the treatment

Cyanide toxicity Remove source 100% oxygen or hyperbaric Tx: with the following Hydroxy cobalamin B12 binds with free cyanide Sodium thiosulfate Amyl nitrate converts hemoglobin to met hemoglobin which scavenges free cyanide Bicarb to correct acidosis

Where does one inject for retrograde cardioplegia? What are the most common indication

Coronary sinus CABG or valve surgery (esp aortic) Anterograde injects into the aorta with a cross clamp

How does aortic crossclamping affect mean arterial pressure and myocardial oxygen demand?

Clamp in dues increase in cardiac after leg raises MAP This increases my patio oxygen and which can lead to LV decompensation and failure

What is a myocardial bridge?

A portion of a major coronary vessel that runs through the myocardium I gets thinner during systole on cath