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Anesthesia Principles II > Cardiac test stuff to memorize > Flashcards

Cardiac test stuff to memorize Flashcards

1
Q

Three meds that increase Calcium by preventing Ca brakdown?

A

PDE inhibitors
glucagon
digitalis

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2
Q

drugs/states that slow ca channels and decrease Ca entry into cardiac cells?

A

acidosis
volatiles
N2O

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3
Q

SNS innervation of the heart?

A

T1-T4 and stellate ganglion

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4
Q

what makes up SV?

A

preload after load and contractility

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5
Q

75% of blood volume resides in?

A

veins

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6
Q

Bainbridge reflex?

A

increased volume in RA causes increased HR by 10-20%

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7
Q

what establishes length of myocyte immediately before isovolumetric contraction?

A

preload

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8
Q

what is the law for wall tension? what is the formula?

A

Law of laplace

T(wall tension)=P (pressure) x (radius)

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9
Q

formula for SVR

A

SVR=80 (MAP-CVP/CO)

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10
Q

normal SVR range?

A

900-1500

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11
Q

normal PVR range?

A

50-150

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12
Q

PNS innervates what in the heart?

A

atria and conduction tissue

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13
Q

what aspects of chemical enviroment affect contractility? what is the most important?

A

Ca, Mg, O2, pH

Ca is the most important

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14
Q

normal EF?

A

68%

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15
Q

Left main coronary artery divides into what?

A

LAD and circumflex

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16
Q

LAD has what branches? what do they supply?

A

1-3 diagonals anterolateral LV

septal branches: septum, bundle branches, purkinje fibers

LAD supplies 45-55% of the LV, runs in inter-ventricular groove

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17
Q

Circumflex supplies what and has what branches that supply what?

A

1-3 obtuse marginals: lateral wall of LV and part of SA node

in 15% of people gives rise of PDA

runs in the AV groove

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18
Q

what does RCA supply and branch into?

A

divides into acute marginal branches

supplies RV, right anterior wall, SA node

gives rise to PDA in 85% of people

SA node in 60% of people

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19
Q

normal CPP?

A

60-80

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20
Q

CPP formula? autoregulated in what range?

A

CPP = AoDBP-LVEDP

50-150

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21
Q

normal O2 content in the blood?

A

20ml/100ml

22
Q

primary determinant of O2 level in the blood?

A

Hgb level

23
Q

MVO2 formula?

A

MVO2=CBF-(CaO2-Cvo2)

24
Q

3 main determinants of myocardial oxygen consumption? What is most important?

A

HR, contractility, and wall stress

HR is the most important one. Doubling HR more than doubles O2 demand, so non linear relationship

25
Q

how to calculate wall stress?

A

Wall stress (tension) = (pressure x radius) / (2 x wall thickness)

26
Q

MAP correlates with, ______ not ______

A

MVO2, not SBP

27
Q

doubling pressure in the heart _____ O2 demand

A

doubles

28
Q

increased pre load increases MVO2 to a _____ ______

A

lesser extent

29
Q

formula for CBP?

A

CPP/CVR

30
Q

normal CBF?

A

225-250ml/min

31
Q

What will increase CVR?

A

increased O2
decreased CO2
decreased H+

increased alpha 1
increased cholinergic tone
increased vasopression
antiogensin
thromboxane

32
Q

what causes decreased CVR?

A

decreased O2
increased CO2
increased H+

increased Beta 1 tone
prostacyclin
NO
endothelial derived hyperpolarizing factor
prostaglandin I2

33
Q

what does alpha 1 stimulation do?

A

constriction, mainly epicardial arteries

34
Q

what does beta 1 stimulation do?

A

dilation, mainly intramuscular arteries

35
Q

how do benzos affect hemodynamics?

A

limited hemodynamic effects

36
Q

why do bad hearts love opioids?

A

decreased O2 demand without decreased contractility

37
Q

what opiod will increase HR and contractility?

A

meperidine (Demerol)

38
Q

CV effects of opioids?

A

decrease SVR (worse with benozs)
decrease Preload (worse with histamine release)
decreased SNS stimulation

39
Q

what are alpha 2 agonists used for in cardiac surgery?

A

decrease HR and BP, used intra-op and post op to decrease opioid requirement, and therefore less resp depression

40
Q

Volatiles effects on on hemdynamics?

A

all decrease contractility and all decrease afterload Sevo<iso and des

minimal chagnes on preload

HR increased with Des>iso>sevo

41
Q

Nitrous Oxide effects on hemodynamics?

A

decreased contractility, increased PVR

42
Q

what to watch for with Succ?

A

bradycardia, espeically with repeat doses

43
Q

how does pancuronium affect hemodynamics?

A

increase HR by 20%, attenuated by high dose narcotic admin

44
Q

how do vec and roc affect hemodynamics?

A

minimal CV effects, possible bradycardia

45
Q

cisatricurium effects on hemodynamics?

A

no effect

46
Q

how soon do you see ST changes?

A

1-2min after ischemia ocurs

47
Q

where do you look for ST chagnes?

A

0.08 seconds after j point

48
Q

which leads are the most sensitive for ischemia? what percentage of ischemia do they detect?

A

2,3, aVF and especially V5

detect 90% of ischemia

49
Q

new onset V wave on PCWP indicates what?

A

papillary muscle dysfunction

50
Q

downstroke on a-line represents what?

A

PVR

Anesthesia Principles II (14 decks)

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