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APEX > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

MAP

A

(1/3 x SBP) + (2/3 x DBP)

Or

[(CO x SVR) / 80] + CVP

~depends which variables you’re given in the question
→ directly affected by: CO, SVR

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2
Q

SVR

A

[(MAP - CVP) / CO] x 80

Normal is 800-1500 dynes/sec/cm^5

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3
Q

PVR

A

[(MPAP- PAOP) / CO] x 80

Normal = 150-250 dynes/sec/cm^5

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4
Q

Law of Laplace

A

Wall stress = (intraventricular pressure x radius) / ventricular thickness

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5
Q

Which 3 conditions set afterload proximal to the systemic circulation?

A
  1. AS
  2. Hypertrophic cardiomyopathy
  3. Coarctation aorta
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6
Q

Coronary perfusion pressure equation

A

Aortic DBP - LVEDP

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7
Q

Which TEE view is best for diagnosing myocardial ischemia?

A

Midpapillary muscle in short axis

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8
Q

Which region of heart is most susceptible to ischemia?

A

LV subendocardium - best perfused during diastole -

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9
Q

Resting membrane potential of cardiac myocyte

A

-Myocyte membrane is permeable to K+, but not other electrolytes or proteins. K+ is the primary determinant of RMP

→ when K+ ↓, RMP → more negative, myocytes harder to depolarize (hypokalemia = harder to depolarize)
→ when K+ ↑, RMP → more positive, myocytes easier to depolarize (hyperkalemia=easier to depolarize, why hyperkalemia → vtach/vfib etc)

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10
Q

Cardiac action potential: SA node

A

4 - 0 - 3

4: spontaneous depolarization = Na+ in, lf or “funny current”
0: depolarization = Ca2+ in
3: repolarization = K+ efflux

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11
Q

Cardiac action potential: ventricle

A

0=depolarization=Na+ in
1=initial repolarization = Cl- in, K+ out
2=plateau = Ca2+ in
3=repolarization = K+ out

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12
Q

Autonomic innervation of the heart

A

At rest, PNS > SNS

PNS: R vagus nerve innervates SA node, L vagus innervates AV node

SNS: cardiac accelerator fibers T1-T4

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13
Q

Normal values: Ca02, D02, V02, Cv02

A

Ca02=arterial 02 content: 20mL/02/dL
D02=delivery: 1000mL/min
V02=consumption: 250mL/min
Cv02=venous 02 content: 15mL/dL

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14
Q

Mechanical/valvular events of systole

A

Isovolumetric contraction:

  • S1, MV closed, AV closed.
  • LV pressure ↑, LV volume constant.

Ventricular ejection:

  • MV closed, AV open → SV ejected into aorta.
  • most of SV ejected during first 1/3 of systole.
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15
Q

Diastole: mechanical, valvular events

A

Isovolumetric relaxation:

  • S2. MV closed, AV closed
  • LV pressure ↓, LV volume constant.

Rapid ventricular filling:

  • MV open, AV closed
  • LV pressure constant, LV volume ↑

DIASTASIS or reduced ventricular filling:

  • MV open, AV closed
  • LV filling still happening, but slows down a lot.

Atrial systole:

  • MV open, AV closed =
  • LA contraction = AV ‘kick”
  • contributes last 20% filling
  • end of atrial systole = EDV
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16
Q

Primary determinants of end systolic volume

A

Afterload (SVR)
Contractility

End systolic volume directly affects: SV, CO

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17
Q

Primary determinants of end diastolic volume or preload

A
  • Filling pressure
  • Compliance

ESV or preload directly affects: SV, CO

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18
Q

Conditions in which PAOP overestimates LVEDP? Underestimates it?

A

OVERESTIMATES:

  • Impaired LV compliance (ischemia)
  • Mitral valve diseas (MS or MI)
  • L → R shunt
  • Tachycardia
  • PPV, PEEP
  • COPD
  • pulm HTN
  • PA cath tip placed outside West zone III

UNDERESTIMATES:
-Aortic insufficiency

19
Q

BP measurement change with height differences

A
  • For every 10 cm change, BP changes by 7.4mmHg

- For every inch change, BP changes by 2mmHg

20
Q

Which leads monitor the CxA?

Which area of the myocardium does this correspond to?

A
  • LATERAL wall

- I, aVL, V5, V6

21
Q

Which leads monitor the RCA?

Area of myocardium?

A

INFERIOR wall

-II, III, avF

22
Q

Which leads monitor the LAD?

Area(s) of myocardium?

A
  • SETPAL:V1, V2

- ANTERIOR: V3, V4

23
Q

02 delivery

A

D02 = Ca02 x CO x 10

24
Q

When is the EKG not an effective intraoperative monitor of myocardial ischemia?

A
  • LV hypertrophy
  • conduction abnormalities
  • V-pace dependent
25
Q

Major determinants of cardiac demand

A
  • Basal 02 needs
  • LV wall tension (↑ preload or ↑ afterload → ↑ tension)
  • HR
  • contractility
26
Q

Why do you need a PA cath to measure Sv02?

A

-Because different organs extract different amounts of 02, a true mixed venous sample must contain blood returning from the SVC, IVC, and coronary sinus. The only place blood from all 3 of these sources mixes is in the pulmonary artery.

27
Q

MR/MI

A

“Fast full forward” sort of…

HR: ↑ normal with NSR
↑ Preload: some SV lost to LA, ↑ preload helps compensate.
(PAOP overestimates LVEDP)

Afterload: ↓ helps promote forward flow

Weird causes you might not think about: muscular dystrophy, scoliosis

28
Q

AR/AI

A

Fast, full, forward

Can be caused by RA, Marfan’s

29
Q

MS

A

Full, slow, tight

HR: low-normal with NSR

Preload: maintain, LV chronically underfilled, but don’t make it too much, hypervolemia → ↑ LAP → ↑ pulm congestion

Afterload: maintain (rapid ↓ SVR → baroreceptor mediated ↑ HR = not good), phenylephrine is ideal

30
Q

Aortic stenosis

A

HR: 70-80, NSR: properly timed atrial contraction imperative

Preload: ↑ : adequate LVEDP to fill noncompliant LV

SVR: maintain or ↑ (phenylephrine usually good)

31
Q

How to think about valvular lesions in the context of pressure volume loops

A
  • Stenotic valves cause pressure overload → change HEIGHT of PV loop
  • Regurgitant values cause volume overload → change WIDTH of PV loop
32
Q

How long should elective surgery be delayed after stent placement?

A
  • DES: 6 months

- BMS: 30 days

33
Q

Types of AAAs that involve the ascending aorta

A

DeBakey 1 and 2

Stanford type A

-All are surgical emergencies
AV often involved so consider AI in your anesthetic plan

34
Q

Contraindications to aortic balloon pump

A
  • Severe AI
  • Descending aortic disease
  • Severe PVD
  • Sepsis
35
Q

Systolic and diastolic murmurs

A

Systolic: MR, AS

Diastolic: MS, AR

36
Q

AoX application: what ↑, what ↓ ?

A

↑ c application:
venous return (blood volume shifts proximal to clamp)
MAP, SVR, PAOP, coronary flow, Sv02 (less consumed so more leftover)

↓ c application:
Renal blood flow (even if clamp is infrarenal), CO, total body V02

37
Q

AoX removal: What ↑, what ↓ ?

A

↑ c removal: PVR, total body V02

↓ c removal: CO, MAP, SVR, venous return, renal blood flow, coronary flow, Sv02

38
Q

Only drugs that can reverse myocardial remodeling

A

ACEIs (-pril)

Aldosterone inhibitors

39
Q

→ of enhanced cardiac silhouette on CXR

A

Pericardial effusion
cardiomegaly
Cardiac aneurysm

40
Q

In an MI/02 supply-demand imbalance situation, which parts of the heart fail in which order?

A

Diastolic dysfunction (↓ ventricular compliance) occurs first.

Systolic dysfunction occurs second. → wall motion abnormalities, usually correlates with ↓ EF. TEE is an excellent monitor of systolic function.

EKG changes occur after systolic dysfunction.

Clinical symptoms after all these.

41
Q

Which 4 conditions WORSEN LVOT in HOCM

A
  • ↓ preload
  • ↓ afterload
  • ↑ HR
  • ↑ contractility

Want to volume load, depress myocardium a little, lower HR, and dilate them

42
Q

LCA

A

Gives rise to circumflex and anterior interventricular arteries

43
Q

RCA

A

Gives rise to PDA and marginal

44
Q

Hyperkalemic EKG signs of pending cardiac arrest needing IMMEDIATE intervention

A

P wave flattening/disappearing
QRS prolongation
QRS → sine wave pattern, then VF, then arrest

APEX (11 decks)

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