Cardiology Exam 1 Flashcards
Systolic dysfunction what is going on with the EF, EDV, and contractility?
reduced EF
reduced contractility
increased EDF
Diastolic dysfunction what is going on with the EF, EDV, and compliance?
preserved EF
reduced compliance
normal EDV
Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary edema
describes what type of heart failure?
Left sided heart failure
Hepatomegaly
JV distension
Peripheral edema
describes what type of heart failure?
Right sided heart failure
Valvular stenosis causes pressure overload or volume overload?
pressure overload
valvular regurgitation causes pressure overload or volume overload?
volume overload
What causes increased afterload?
systemic hypertension
Increased preload leads to symptoms of pulmonary vascular congestion
Symptoms would include what three things?
Dyspnea
Orthopnea – SOB when supine (gravity effect)
Paroxysmal nocturnal dyspnea, pulmonary edema
(all left sided failure issues)
most common cause of left-sided heart failure is?
right sided heart failure
COPD can cause which side of the heart to fail?
the right ventricle
If COPD was to cause right sided heart failure what would happen to the pulmonary vascular resistance and right sided pressure?
increase in pulmonary vascular resistance, resulting in right-sided pressure overload
Backward congestion symptoms would include?
Dyspnea , orthopnea, PND
JV distension (increased venous pressure)
Peripheral pitting edema
Signs of CHF?
Tachycardia S3 (ventricular gallop) , S4 (atrial gallop) Rales Cardiomegaly Ascites Hepatic congestion (increased CVP)
What is a normal BNP?
Less than 100 thus it is elevated (100-300) the heart is starting to fail.
an echo can tell you what?
systolic and diastolic dysfunction
what meds reduce afterload and improve survival?
ACE inhibitors or ATR blockers
What meds treat diminished contractility?
Digoxin
Beta agonist – dopamine
Amrinone (PDE inhibitor)
What do you have the beware of with digoxin?
Inhibit Na/K ATPase
BEWARE digoxin toxicity with hypokalemia (with diuretics) , elderly and renal insufficiency
If you have digoxin toxicity what will you see on an EKG?
PVC’s
ST depression ‘ dig effect’
Paroxysmal atrial tachycardia with varying block
Anesthesia concerns with CHF?
watch fluid status very carefully!
avoid nitrous oxide in sever CHF
arrhythmias are poorly tolerated
Treatment of heart failure, what does ABCDE stand for?
ACE inhibitors Beta-blockers Calcium channel blockers Diuretics Endothelin receptor blockers leads to decrease pulmonary vascular resistance
vasodilation = endothelin receptor blocker.
What is the major determinant of intravascular volume in the body?
Na+
What is the most important hormone for controlling vascular volume?
aldosterone
What two factors determine preload?
intravascular volume and venous tone
venous constriction leads to what?
high preload
stroke volume is determined by three factors?
preload
afterload
contractility
CO =?
Stroke volume x HR
Mean arterial pressure = ?
CO x SV
What is normal EF?
60-80%
EF = ?
stroke volume / end diastolic volume
EF is an index of ventricular contractility which is a measure of what function?
systolic function
What is normal SVR?
1200-1500 dynes/sec/cm-5
what is the major determinant of SVR?
Arterioles
SVR =?
MAP-CVP/CO X 80
What % of cardiac output goes towards coronary circulation?
5% = 250ml/min @ rest
When does maximum flow of blood occur to the coronary arteries?
during diastole
If you have diastolic dysfunction what blood supply can that interrupt?
coronary blood supply bc it occurs during diastole
Two ways to cause vasodilation in the heart vessels?
hypoxia and adenosine
What factors reduce coronary blood flow?
tachycardia
aortic stenosis
When talking about the heart, increase in demand for oxygen must be met with?
increased blood flow bc the myocardium sucks all the oxygen from the arterial blood.
What are the two major determinants of flow to the heart?
LVEDP and HR
supply vs demand
Most volatile anesthetics do what to the heart? (making them ideal for MI)
coronary vasodilators!
When is the right ventricle perfused compared to the left ventricle?
The right Ventricle is perfused throughout systole and diastole but flow to the left ventricle is largely limited to diastole
What all can decrease coronary perfusion?
decreased aortic pressure
increased LVEDP
increased HR
Two kinds of hypertrophy of the myocardium, what are they?
concentric (pressure) and eccentric (volume) hypertrophy.
what is concentric hypertrophy?
pressure will increase the thickness of the myocardium wall but does not increase chamber size.
What is Eccentric hypertrophy?
volume will increase the size by literally increasing the size of the heart chamber but not so much the mass/thickness of the wall.
Due to chronically elevated afterload describes?
Concentric hypertrophy (pressure overload)
Due to chronically elevated preload describes?
Eccentric hypertrophy (volume overload)
volume pressure loop that is longer than taller shows what?
increasing preload
volume pressure loop that is taller than it is long shows what?
increasing afterload
How does the P-V loop change in systolic failure?
diastolic portion of the P-V loop has shifted to the right.
How does the P-V loop change in diastolic failure?
diastolic portion of the P-V loop has shifted up.
What chamber of the heart is affected by mitral valve stenosis
The left atrium must work harder to push blood through the damaged valve and enlarges as a result.
What is normal left atrial pressure?
8 is normal
If you have mitral stenosis what will your left atrial pressure look like?
25/14 (high), increased wedge pressure
P-V loop of mitral stenosis looks like what?
everything is decreased bc their is less filling of the left ventricle
What valve issue can cause pulmonary congestion, coughing up blood with extreme congestion?
Mitral Stenosis
With mitral stenosis what is going on with the left ventricle?
LV is typically perfect!
symptoms of mitral stenosis?
Dyspnea, orthopnea , PND (due to pul. congestion) “backup”
Hemoptysis
A. fib leading to embolization
Medical therapy for mitral stenosis?
Diuretics for pulmonary congestion
Digoxin
Anticoagulant
Anesthetic concerns with someone who has mitral stenosis?
Maintain sinus rhythm , avoid tachycardia
Tachycardia decreases diastolic time leading to lesser filling
Avoid fluid overload and hypovolumia
Avoid spinal/epidural nerve block
Afterload reduction
Beta blockers for tachycardia
Diltiazem and digoxin in A fib
Phenylephrine as vasoconstrictor
How do you want the HR for mitral stenosis?
slow (low HR), this allows time for blood to fill the left ventricle.
What do you want the rhythm to be with mitral stenosis?
regular
What valve issue causes straightening of the left border of the heart?
mitral stenosis
What is valvular regurgitation?
when blood leaks in the wrong direction bc one or more of the heart valves closes improperly.