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MIDTERM > Cardiac Midterm > Flashcards

Cardiac Midterm Flashcards

1
Q

What is the ratio in the Na/K pump?

A

3 Na out and 2 K in

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2
Q

What happens during phase 0 on the cardiac action potential?

A

Na in

Initial upstroke

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3
Q

What happens during phase 1 on the cardiac action potential?

A

K out
Cl in

First downstroke

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4
Q

What happens during phase 2 on the cardiac action potential?

A

K out
Ca in

Flat plateau

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5
Q

What happens during phase 3 on the cardiac action potential?

A

K out

Final downstroke

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6
Q

What happens during phase 4 on the cardiac action potential?

A

Na out

Resting phase. flat line

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7
Q

Intrinsic firing rate for each tissue?

A

SA node 70-80
AV node 40-60
Purkinje fibers 15-40

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8
Q

Normal DO2?

A

1000ml/min

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9
Q

Normal CaO2?

A

20ml/dl

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10
Q

Normal extraction ratio?

A

25%

250mL/min

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11
Q

Normal VO2?

A

250mL/min

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12
Q

What determines blood viscosity?

A

Hct and body temp

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12
Q

When is the LV sub endocardium best perfused?

A

Diastole

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13
Q

What percentage of blood goes to the coronaries?

A

5% or 250ml/min

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14
Q

When is the RV sub endocardium best perfused?

A

Throughout

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15
Q

When do most perioperative MIs occur?

A

24-48 hours post op

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16
Q

Steps in the nitric oxide pathway?

A

L arginine to nitric oxide

2.Nitric oxide activates gmp

3.gmp is converted to cGMP

4.cGMP reduces Ca and leads to relaxation

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17
Q

What does S3 signify? Where is it heard?

A

Heart failure

Just after S2 (gallop or rumble)

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18
Q

What does S4 signify?

A

Atrial systole

Before S1

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19
Q

Normal valve orifice for AS?

A

2.5-3.5cm

Severe is <0.8

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20
Q

What is the triad for AS?

A

SAD

Syncope
Angina
Dyspnea

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21
Q

Anesthetic management for AS?

A
  1. Preload - Increase
  2. HR - 75 and NSR
  3. SVR- Maintain or increase

AVOID spinal

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22
Q

Most common cause of AS?

A

Calcification

Rheumatic fever
Endocarditis

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23
Q

Normal mitral valve orifice?

A

5cm

-Severe <1
-Pressure gradient exceeds 10
-PA greater than 50

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24
Q

Most common cause of MS?

A

Endocarditis in USA

Rheumatic fever in world

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25
Q

Management of MS?

A
  1. Preload - Maintain
  2. HR - 75 and NSR
  3. SVR- Maintain

AVOID increase PVR

AVOID spinal

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26
Q

Management of Mitral regurgitation

A

HR - Increase
Preload- Maintain
Afterload - Decrease

Avoid increase in PVR

Okay for regional

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27
Q

What to avoid with mitral valve conditions?

A

Increase in PVR

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28
Q

What is a risk after a mitral valve repair?

A

SAM - systolic anterior motion

Treat wit fluids and increasing afterload

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29
Q

Treatment of aortic regurgitation?

A

Full, Fast, Foward

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30
Q

Murmurs - AS?

A

ASSS

Aortic
Stenosis
Systole
Sternal border (R)

31
Q

Murmurs - Aortic regurg?

A

ARDS

Aortic
Regurgitation
Diastole
Sternal border (R)

32
Q

Murmurs - MS?

A

MSDA

Mitral
Stenosis
Diastole
Apex and L Axilla

33
Q

Murmurs - Mitral regurgitation ?

A

MRSA

Mitral
Regurgitation
Systole
Apex and L Axilla

34
Q

When is the highest likelihood of reinfarction of an MI?

A

Within 30 days

35
Q

HF classification system?

A

1-Asymptomatic
2 Symptomatic with moderate exercise
3 Symptomatic with mild exercise
4 Symptoms at rest

36
Q

How to treat an MI?

A

Slower
Smaller
Better perfused

37
Q

Better biomarkers, troponin or CK-MB?

A

Troponin

Peak in 24 hours and returns to baseline in 10 days

38
Q

How long after an MI will you see an increase in cardiac biomarkers?

A

3-12 hours

39
Q

What is the most common cause of R heart failure?

A

l heart failure

40
Q

How does nitrous affect PVR?

A

INCREASES

41
Q

What increases PVR?

A

Hypoxia
Hypercarbia
Acidosis

42
Q

What BP is considered a hypertensive crisis?

A

> 180/120

43
Q

What is Kussmauls Sign?

A

*Constrictive pericarditis

Increased CVP during inspiration

JVF

44
Q

What to avoid in Pericarditis?

A

Bradycardia

45
Q

What is Becks Triad?

A

Cardiac Tamponade

Hypotension
JVD
Muffled heart tones

46
Q

Anesthetic management of Cardiac tamponade?

A

Local anesthetic

**Maintain spontaneous ventilation

++Ketamine

Maintain or increase all parameters

47
Q

When is antibiotic prophylaxis not required for endocarditis?

A

Stent
CABG
Unrepaired valve

GI or GU procedures

48
Q

Treatment for HOCUM?

A

Preload- Increase
Contractility - Decrease
HR - Decrease
Afterload - Increase

49
Q

Stent recommendations?

A

No stent - 4 weeks
Bare metal - 6 weeks
Drug eluting - 1 year
CABG - 6 weeks

49
Q

When should aspirin be stopped ?

A

3 days

50
Q

When should Plavix be stopped?

A

7 days

51
Q

When should Ticlopidine be stopped?

A

14 days

52
Q

Goal for PCI timeline?

A

<90 minutes

53
Q

What can be given to reverse platelet inhibition?

A

Platelets

54
Q

What type of CPB is preferred? Why?

A

Centrifugal - less traumatic to blood cells

*reduced risk of air

55
Q

What should the ACT be before going on pump?

A

> 400 seconds

56
Q

General rule for protamine dose?

A

1mg per 100 units

57
Q

When is surgical intervention recommended for a AAA?

A

> 5.5 cm

58
Q

Triad of a AAA?

A

Back pain
Hypotension
Pulsatile abdominal mass

59
Q

What is the artery of Adamkiewicz?

A

Most important radicular artery

Perfuses anterior spinal cord

60
Q

What is maintained during anterior spinal artery syndrome?

A

Touch and proprioception

61
Q

What is subclavian steal syndrome ?

A

Occurs on the left side

Diverts blood away from brain to ipsilateral side

62
Q

What increases contractility?

A

Chemicals and Calcium

63
Q

What law can describe afterload?

A

Law of LaPlace

64
Q

Which two conditions set the afterload?

A

AS
Coarctation of the aorta

65
Q

What is the best TEE view for diagnosing MI?

A

Midpapillary level on short axis

66
Q

How does cGMP affect Ca????
***

A

Reduces calcium

67
Q

Most common dysrhythmia with MS?

A

Afib

68
Q

Six factors for increased morbidity and mortality?

A

-High risk surgery
-History of ischemic heart disease
-History of CHF
-History of cerebrovascular disease
-DM
-Creatine >2

69
Q

Which HF has a preserved ejection fraction? What is the issue?

A

-Systolic
-Ventricle doesn’t empty well

70
Q

Which HF has a preserved EF?

A

Diastolic

Issue is the ventricle is not filling

71
Q

What is the difference between primary and secondary HTN?

A

Primary - unable to find a cause

Secondary - Caused by some other pathology

72
Q

*****Key sign of pulsus paradoxus?

A

SBP drops by 10 or more points on inspiration

73
Q

What drugs are okay in cardiac tamponade?

A

MIDTERM (6 decks)

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