Cardiac OA Questions

Question 1

Hypoxia Pul Vasoconstriction happens when and why?

Answer 1

During decreased partial pressure of oxygen. It serves to match ventilation and perfusion in the presence of lung disease or during OLV

Question 2

T/F-Catecholamines increase HPV. What has no effect on it?

Answer 2

True. Propofol, opioids and benzodiazepines have no effect on HpV. Anesthetic gas decreases the effect

Question 3

Of the CO2 is high (resp acidosis), during CPB-what can you do?

Answer 3

Change oxygenate flow via CPB machine. Increase oxygenator flow if CO2 is too high, decrease of it is too low

Question 4

LAD supplies which ventricle walls? What would you see on EKG in occlusion of LAD?

Answer 4

Anterior and anterolteral. With LAD occlusion, you’d see ST elevation in V1-V6, with maybe some aVL

Question 5

ECG findings with occlusion of the LCX?

Answer 5

1, aVL, V5-V6 with reciprocal depression in III and AVF

Question 6

Which gas is used to inflate IABP? Tell me about it.

Answer 6

Helium. It’s used because the low density allows for rapid inflation, but if the balloon bursts, a helium embolism can be more catastrophic (due to low solubility in blood) than a CO2 embolism

Question 7

T/F-Verapamil is a positive inotrope

Answer 7

False! It is a negative inotrope, and it is associated with heart failure

Question 8

What is the vasodilator test, and what do you do if it’s positive? Negative?

Answer 8

It uses NITRIC oxide to see if the pulmonary vasculature will vasodilate. Reduction in mean pulmonary art pressure of >\40 or mean pulmonary pressure of greater/equal to 10 is positive, and you can use CCB for tx of pul HTN-but NOT verapamil. If they don’t have a positive test, they can have endothelin antagonists, phosphodiesterase inhibitors, endothelium receptor antagonists , or epoproatenol(prostacyclin-for severe)

Question 9

In Mittal stenosis, what are the thatca increase left atria pressure?

Answer 9

Increasing the HR-which ketamine can do.

Question 10

What is the formula for coronary perfusion pressure?

Answer 10

Aortic diastolic pressure-LVEDP

Question 11

Urine creatinine clearance numbers-

Answer 11

25-40 moderate

40-60 is mild

Question 12

Most sensitive detection for VAE?

Answer 12

TEE

Question 13

You need to reverse a lady quickly who has an INR of 3.8 for an emergent procedure. What do you choose?

Answer 13

PCC over FFP

Question 14

Clues of cyanide toxicity due to nitroprusside, and how do you officially diagnose it?

Answer 14

Increased Venous O2, tachyphylaxis, hypertension, metabolic acidosis, cardiac arrhythmia and CNS dysfunction. Officially diagnose clinically. D/c nitroprusside, give sodium thiosulfate followed by sodium nitrate (oxidizes HGb to methgb) and then methylene blue

Question 15

What are the RA, RV, LV doing during cardiac tamponade? And what is the most specific sign of tamponade?

Answer 15

RA and RV collapse, IVS bulges from right to left, and LV collapse is very specific

Question 16

MOA of milrinone?

Answer 16

Decreased hydrolysis of cAMP in mycoardium leading to increased inotropy. Milrinone is also a pulmonary vasodilator and can decrease PVR in pts with RV dysfunction and pulmonary vasoconstriction

Question 17

So, how can we use an arterial line to tell us things about contractility, PVR, or volume status?

Answer 17

Upstroke: contractility, downstroke: PVR, and as far as hypovolemia; if you see excessive variations in systolic blood pressure with respirations, thats a sign of hypovolemia.

Question 18

What are the phenomena that occur as arterial line monitoring gets farther away from the body? And what does this even mean?

Answer 18

Distal pulse amplification and pressure wave reflection. In peripheral compared to central arterial waveforms, there is a steeper arterial upstroke, a higher systolic peak, a later dicrotic notch, a more prominent diastolic wave, and a lower end-diastolic pressure. Pressure wave reflection occurs due to the sudden increase in vascular resistance at the arteriolar level, which causes diminished pressure pulsations in more distal vessels and augments upstream arterial pressure. This causes differences in the shape of the arterial pulse wave at different sites in the body (Figure 1-1). As arteries become stiffer with age, pulse pressure increases, the systolic pressure peaks occurs later, and the diastolic pressure wave disappears.

Question 19

Pulsus paradoxus:

Answer 19

Fall in arterial pressure >10 mmHg during inspiration-which is an exaggeration of the normal decrease.

Question 20

Suprarenal cross clamp vs infrarenal in a normal patient:

Answer 20

suprarenal: minimal hd compromise, and maybe even increased CO. with the other: HTN above crossclamp, and hypotension below. Can have decreased EF, decreased CO, and decreased RBF. Increases seen in PCWP and CVP, coronary blood flow, and mixed venous O2 sat d/t decreases in o2 consumption and extraction.

Question 21

CVP corresponds to what?

Answer 21

The central venous compartment corresponds to the volume enclosed by the right atrium and the great veins in the thorax. Central venous pressure (CVP) is the intravascular pressure in the great thoracic veins, measured relative to atmospheric pressure. It is conventionally measured at the right atrium-superior vena cava junction and provides an estimate of the right atrial pressure.