Cardiology

Question 1

What is the most important determinant of myocardial oxygen supply?

Answer 1

Heart rate: this is because slower HR equals more diastolic filling and better coronary perfusion.

Question 2

What at the ECG changes seen with LVH? RVH?

Answer 2

1) LVH: Add the R wave in aVL and the S wave in V3 and if >28 in M and >20 in F then LVH
2) RVH: R wave in V1 > 7 small squares in amplitude

Question 3

When is aortic aneurysm repair indicated?

Answer 3

If the AA is >5.5 cm or has >1cm growth in a year

Question 4

How do you decrease the windsock effect during TAA repair?

Answer 4

1) hypotension with SBP less than 70-80
2) transient cardiac arrest with adenosine
3) Rapid ventricular pacing via wires to >180

Question 5

What does the dicrotic notch represent on the A line tracing?

Answer 5

Closure of the aortic valve

Question 6

What are 7 hemodynamic changes seen with aortic cross clamping?

Answer 6

1. Increased arterial BP above the clamp (same amount of blood in a smaller space), decreased aterial BP below the clamp
   2) Increased Pulm. A wedge pressure
   3) Increased catecholamine’s leading to vasoconstriction and INCREASED CVP
   4) Increased coronary a. blood flow
   5) Increased LV wall stress
   6) Decreased CO
   7) Decreased RBF

Question 7

What is the Fick equation? What does it tell us?

Answer 7

Sv02 = Sa02 - [VO2/(COHgb1.36)]
Sv02: mixed venous
SaO2: arterial oxygen
V02: total body o2 consumption

• • normal SvO2 is 75%, meaning that the body extracts 25%
• • SV02 increases when you cannot extract O2 from the body, such as in sepsis, methemoglobinemia, CO or cyanide poisoning

Question 8

Describe the values seen in Cardiogenic shock

Answer 8

1. Decreased CI

2. Increased PCWP, CVP, and SVR

Question 9

What are the normal pressure values of the heart?

Answer 9

1. CVP: 2-6
2. PCWP: 6-12
3. CI: 2.5-4
4. SVR: 800-1200

Question 10

Describe the values seen in distributive shock

Answer 10

Low SVR, Increased CI, no changes to the PCWP or CVP

Question 11

Describe the values seen in hypovolemic shock

Answer 11

Increased SVR, Decreased CVP, Decreased or normal PCWP, Decreased CI

Question 12

What coronary artery supplies the AV node?

Answer 12

The PDA, and in R dominant patients this means that an MI involving the RCA could lead to AVB

Question 13

What does TAPSE stand for? What is it a marker of?

Answer 13

Tricuspid annular plane systolic excursion <1.6 shows that there is RV reduced fxn

Question 14

What is the difference between a BiVAD and a total artificial heart?

Answer 14

BiVADs are short term, whereas total artificial hearts can be left in long term and are good for bridging a patient in severe heart failure to transplant

Question 15

What is considered low risk when stopping warfarin?

Answer 15

Bicuspid aortic valve prosthesis who are in NSR with no other risk factors

Question 16

Define Pulsus paradoxis

Answer 16

A drop in systolic BP >10 mmHg seen in inspiration aka pulsus paradoxis

Question 17

What electrolyte abnormality will increase the effect of digoxin?

Answer 17

HYPOkalemia

Question 18

What are the sxs of neurogenic DI? what is the first line treatment

Answer 18

1. hypotension 2. polyria

1st line tx is vasopressin

Question 19

Fenoldopam

Answer 19

D1 agonist that vasodilates and reduces both preload and afterload. Useful when you need to perfuse the kidneys and help with hypertension

Question 20

Nesiritide

Answer 20

Recombinant BNP: causes diuresis, naturesis, and vasodilation

Question 21

How is esmolol metabolized?

Answer 21

By red blood cell esterases

Question 22

Which BB is metabolized by the kidneys?

Answer 22

Atenolol (think ATNolol)