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Coexisting > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is the Etiologu and Diagnosis of Acute Pericarditis?

When do they occur?

When does it worsen?

A
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2
Q

What is the treatment for Acute Pericarditis?

Medications

What is reserved for cases that don’t respon to conventional treatment?

A
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3
Q

This is an accumulation of pericardial fluid in the perdicardial sac

normally 15 - 100 ml of fluids

A
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4
Q

What are the S/S of a patient that has cardiac tamponade?

A

mild to severe that occurs gradually.

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5
Q

What are the s/s of chronic cardiac tamponade?

A

Signs:

  • tachycardia
  • JVD
  • hepatomegaly
  • peripheral edema
  • CVP almost always increased
  • Tamponade may be the cause of low cardiac output post cardiac surgery
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6
Q

Tamponade can happen chronically,

as cardiac tamponade progresses there will be equalization of pressure –

A

Equalization of pressures:

Equalization of LA pressures with RV end diastolic pressure –> impaired diastolic filling pressure of the heart –> decrease stroke volume –> decrease CO

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7
Q

How do we diagnose tamponade?

What is a difinitive measure?

A
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8
Q

How do we treat tamponade?

Recommendations for pericardiocentesis procedure

A

No general anesthesia if pericadiocentesis is the plan.

Recommendation: very acute severe cardiac tamponade

Light sedation –

local anesthetic

**hand holding

—> sometimes tamponade is severe enough that patient will arrest if put on GA

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9
Q

What is chronic constrictive pericarditis

A
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10
Q

What is the definitive treatment of Chronic Constrictive pericarditis

When do you expect hemodynamic improvement?

A

surgical removal of constricting pericardium (pericardial stripping)

– expect improvement in 3 months (its slow)

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11
Q

What is the anesthetic management of Constrictive Pericarditis

what are the hemodynamic changes that you want minimized?

A

**heavy handed on opiods**

*tend to be long cases**

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12
Q

What is a most serious aneurysm?

what are we concerned about?

A

dilation to all 3 layers if an artery

50 % increase in diameter

-

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13
Q

Where do most dissection commonly happens?

What are the factors in aneurysmal disease?

What are Causes of dissection?

A

most commonly happens in the thorax in the ascending aorta

What are the factors in aneurysmal disease?

  • Atherosclerosis (80%)
  • HTN
  • Older age
  • Male sex
  • Family Hx of aneurysmal disease
  • Smoking

Causes:

– Blunt trauma, cocaine use, iatrogenic dissection d/t aortic cannulation, systemic HTN, chronic dissection (17%)

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14
Q

most common symptom of aneurysm

A

back pain

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15
Q

Thoracuc Aortic Aneursym Inherited disorders

A
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16
Q

Thoracoabdominal Aneurysm Classifications

A

Type 2 crosses the diaphragm

Type 3 also crosses

Type 4 below diaphragm

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17
Q

DeBakey Classification

A
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18
Q

What are S.S of TAA

A

often asymptomatic

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19
Q

S/S of TAA

dissecting**

A
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20
Q

What is the mechanism of cardiac tamponade in TAA

A

Cardiac Tamponade in TAA:

Retrogade dissection of sinus of valsava in the pericardial space

—> major cause of death

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21
Q

How di we diagnose TAA?

A
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22
Q

Type A Dissection

what is the mortality?

A
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23
Q

Type B Dissection

where is it?

what is the mortality?

A
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24
Q

when do we repair TAA?

A
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25
Q

What is the single most determinant of paraplegia and renal failure?

A

duration of aortic cross clamping

clamp and sew technique**

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26
Q

What are Unique Risk for Surgery

A
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27
Q

What artery greatly affects the chances of paraplegia?

A

Artery of Adamkiewicz

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28
Q

What are the Hemodynamic Responses to X - Clamping

A

Thoracic aortic clamping and unclamp-
ing are associated with severe hemodynamic and homeostatic disturbances in virtually all organ systems owing to decrease in blood low distal to the X-clamp and substantial increase in blood low above the level of aortic occlusion.

Increased systemic vascular resis-
tance (SVR), decreased cardiac output (CO), and no change in heart rate are common. The level of X-clamp is critical to the nature of hemodynamic change: minimal with infrarenal X-clamp, and dramatic with intrathoracic X-clamp.

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29
Q

What are the hemodynamic Responses to Unclamping

Gradual release of cross clamp?

A

Gradual release of the aortic clamp is recommended to allow time for volume replacement and to slow the washout of the vasoactive and cardiodepressant mediators from ischemic tissues

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30
Q

Anesthetic Management of TAA

What is renal protection for Thoracic Surgery?

A

Renal Protection (4 C LR with 25 g mannitol/L directly into renal artery by surgeon)

31
Q

Post - Operative Management TAA

A

Postoperative Management. Amelioration of pain is essential for patient comfort and to facil-
itate coughing and maneuvers designed to prevent atelectasis. If neuraxial analgesia is used dur-
ing the immediate postoperative period, opioids are preferred over local anesthetics to prevent
masking of anterior spinal artery syndrome (LOSS OF MOTOR FUNCTION, PAIN AND TEMP SENSATION AND HYPOTENSION). Patients recovering from thoracic aortic aneurysm
resection are at risk of developing cardiac, pulmonary, and renal failure during the immediate
postoperative period. Systemic hypertension may require treatment with drugs such as nitroglycerin, nitroprusside, hydralazine, and labetalol.

32
Q

Mechanism/ cause of Abdominal Aortic Aneurysm

A
33
Q

Treatment and Evaluation of AAA

A
34
Q

PreOperative Evaluation of AAA

A

Preoperative Evaluation. Coexisting medical conditions, especially coronary artery disease,
COPD, and renal dysfunction, are important to identify preoperatively. Myocardial ischemia
or infarction is responsible for most postoperative deaths ater elective abdominal aortic aneu-
rysm resection. Preoperative evaluation of cardiac function might include stress testing with
or without echocardiography or radionuclide imaging. Severe reductions in vital capacity and
forced expiratory volume in 1 second and abnormal renal function signiicantly increase the
risk of elective aneurysm repair.

35
Q

Ruptured AAA

A
36
Q

Where does ruptured AA seen often?

A
37
Q

Management of Ruptured AA

A
38
Q

Managament of Anesthesia

A
39
Q

Management of Anesthesia

Monitoring

Volume

Induction and Maintenance

A
40
Q

Where is hypotension from AA

A

central hypovolemia

41
Q

Postoperative Management and Complications

A

Postoperative Management

  1. Analgesia. Adequate analgesia from use of either neuraxial opioids or patient-controlled
    analgesia is very important in facilitating early tracheal extubation.
  2. Systemic Hypertension. Systemic hypertension is common during the postoperative period
    and may be more likely in patients with preoperative hypertension.
42
Q

Time of Spinal cord injury

A

12 hrs to 21 days

43
Q

Endovascular Aortic Repair Aortic Aneurysm

A

Management of Endovascular Repair

  • GA or regional anesthesia
  • A-line, Foley
  • Possible convert to open
  • Large bore IVs
  • Maintain Evolemia and normotension
  • Spinal Drain for thoracic cases
44
Q

Carotid Artery Disease and Stroke

A

most are ischemic

45
Q

Risk Factors that are Associated with Stroke

A
46
Q

Circle of Willis

which of these areteries are unpaired?

A

1 Anterior Communicating Artery

2 Anterior Cerebral Artery

2 Posterior Communicating Arteries

47
Q

Where does carotid stenosis most commonly occur and why?

A

bifurcation of the internal and external carotid arteries because of turbulent flow.

48
Q

What are the treatment of Stroke?

tPa recommendation?

Interventional neuroradiology?

A

FDA –> w/in 3 hours of stroke

American Heart –> within 4 hours of stroke onset

Interventional Neuroradiology -> up to 8.5 hours

49
Q
A
50
Q

What is Carotid Endarterectomy (CEA)

A
51
Q

PreOp Evaluation for CEA

WHAT IS A MAJOR MORBIDITY AND MORTALITY IN THESE PATIENTS?

A

Preoperative MI

52
Q

What should you be careful with in management of CEA?

A
  • careful control of HR, BP, pain, and stress response
  • Regional or general anesthesia
  • BP control is important
    • Elevated BP during X- clamping is warranted
    • But elevated BP after surgery may predispose to hematoma formation
  • Normocarbia is recommended
  • A- line , possibly (not usually necessary)
  • Monitoring for cerebral ischemia, hypoperfusion, and cerebral emboli
    • ​EEG, SSEP, Transcranial doppler, shunt placement
53
Q

Anesthetic Management of CEA

A

vagal responses is possible during manipulation

54
Q

Cerebral monitoring for CEA

A
55
Q

What does GA do for CEA?

A

***SEVERE VAGAL response**

**barbs and propofol prior to cross clamping**

56
Q

Post- Operative Management of CEA

How much Nipride?

How much Nitro?

How do you treat carotid sinus sensitivity?

A

0.5 mcg/kg/min

Nitro - 5 mcg/min

57
Q

What are the complications of CEA?

A

Rucurrent laryngeal nerve –> vocal cord paralysis

58
Q

Peripheral Vascular Disease

A
59
Q

What are the medical therapy for PAD

how about surgical?

A
60
Q

Anesthesia Management for surgical repainf of PAD

WHEN do you do epidural?

A

an hour before

61
Q

What is Reynaud;s Phenomenon?

Who is more affected?

What are the secondary causes?

A

crank bair hugger

** give midaz for anxiety

62
Q
A
63
Q

PVD

A

Virchow’s triad

64
Q

What is the recommendation for DVT

A

should be on before you start GA

65
Q

Systemic Vasculitis

Takayasu’s arteritis

Anesthesia Management**

A

Takayasu’s arteritis is an idiopathic, progressive occlusive vasculitis that
causes narrowing, thrombosis, or aneurysms of systemic and pulmonary arteries. It is diag-
nosed deinitively based on contrast angiography.

Treatment is Corticosteroids. Anticoagulation may be indicated in some patients.

66
Q

Takayasau’s Arteritis

Treatment

A

noninvasive blood pressure monitoring may not be accurate because of subclavian and brachial artery stenosis

67
Q

Temporal (Giant Cell) Arteritis

A
  • Temporal arteritis is inlammation of the arteries of the head and neck, manifesting as headache, scalp tenderness, or jaw claudication. Prompt initiation of treatment with corticosteroids is indicated in patients with visual symptoms to prevent blindness. Evidence of arteritis on a biopsy specimen of the temporal artery is present in approximately 90% of patients.
68
Q

Kawasaki’s Syndrome

s/s

treatment

A

Kawasaki’s syndrome (mucocutaneous lymph node syndrome) occurs primarily in children and manifests as fever, conjunctivitis, inlammation of the mucous membranes, swollen erythematous hands and feet, truncal rash, and cervical lymphadenopathy and
vasculitis.

Tx: Treatment consists of γ-globulin and aspirin.

Management of Anesthesia. With regard to anesthesia, the possibility of intraoperative
myocardial ischemia must be considered.

69
Q

Thromboangiitis Obliterans (Buerger’s Disease)

young man’s disease

A
70
Q

Wegener’s Granulomatosis

A

Wegener’s granulomatosis is characterized by formation of necrotizing granulomas in inlamed blood vessels in multiple organ systems

  1. Treatment. Treatment with cyclophosphamide can produce remissions in approximately
    90% of patients.
  2. Management of Anesthesia. In patients with Wegener’s granulomatosis, management of
    anesthesia requires an appreciation of the widespread organ system involvement of this disease. Immunosuppression results from cyclophosphamide treatment. Avoidance of trauma during laryngoscopy is important because bleeding from granulomas and dislodgment of friable ulcerated tissue can occur. A smaller than expected endotracheal tube may be required if the glottic opening is narrowed by granulomatous changes. Arteritis involving peripheral vessels may interfere with placement of an indwelling arterial catheter to moni- tor blood pressure or may limit the frequency of arterial punctures to obtain samples for blood gas analysis.

***becareful with blood pressure and RENAL PERFUSION**

71
Q
A
72
Q

Polyarteritis Nodosa

A

Polyarteritis nodosa most oten occurs in women, often in association
with hepatitis B antigenemia and allergic reactions to drugs. Renal failure is the most common
cause of death.

  1. Diagnosis. The diagnosis depends on histologic evidence of vasculitis on biopsy and dem-
    onstration of characteristic aneurysms on arteriography.
  2. Treatment. Treatment usually includes corticosteroids and cyclophosphamide, removal of
    ofending drugs, and treatment of underlying diseases such as cancer.
  3. Management of Anesthesia. In patients with polyarteritis nodosa, management of anes-
    thesia should take into consideration the likelihood of co-existing renal disease, cardiac disease, and systemic hypertension. Supplemental corticosteroids may be indicated.
73
Q
A

Coexisting (2 decks)

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