Cardiac Keywords Flashcards
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
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
Which walls of the LV are visible on the ME to chamber view?
The anterior and inferior walls
LA appendage is also visible
ME bicaval view
Which Chambers can you see
RA and LA
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
Which part of the heart does the Vegas nerve innervate
Which neurotransmitter does it use
The SA and AV node
Acetylcholine
At which spinal levels are the cardio accelerator fibers found
T1 -T4
Name the sympathetic ganglion in the neck abdomen and pelvis
Neck stellate ganglion
abdomen celiac plexus mesenteric and hypogastric’s
pelvis ganglion impar
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
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
Which wavelengths are preferable for penetration
Large wavelengths have better penetration while smaller wavelengths a better resolution
I wonder what condition do you have increased stroke volume variation with respiration
With low preload
IVC greater than 2cm and no resp variation
Elevated CVP
What three factors affect SVO2 (mixed venous oxygen sat)
CO
VO2
CaO2 (oxygen content of arterial blood)
What is a normal SVO2 measured at the tip of a PAC?
68-77% (PvO2 38-42 mmHg)
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
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)
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
How long do you delay surgery after a BMS vs a DES?
BMS: 30d
DES: 365d
Under what circumstances would you discontinue a stent patients antiplatelet regimen?
Nonelective surgery
Risk of bleeding is higher than stent thrombosis
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?
No
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
