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Advanced Principles C > Cardiovascular Anesthesia Pt. 1 (Exam III) > Flashcards

Cardiovascular Anesthesia Pt. 1 (Exam III) Flashcards

1
Q

What are some risk factors for CAD?

A
  • Male
  • Age
  • ↑ cholesterol
  • HTN
  • Smoking
  • DM
  • Obesity
  • Sedentary lifestyle
  • Genetics
  • Personality/Stress
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2
Q

Angina is an imbalance between myocardial _____ and ______.

A

demand & supply

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3
Q

What is the pain pathway of angina?

A

Partially occluded coronary artery
→ Adenosine, bradykinin, lactic acid release
→ nociceptive receptors w/ afferent neurons to upper five thoracic sympathetic ganglia
→ thalamic & cortical stimulation = pain

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4
Q

Which spinal levels are responsible for myocardial pain receptors?

A

Thoracic 1 - 5

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5
Q

What are the two types of angina?

A
  • Chronic (stable) angina = no change in pain intensity or duration over 2 months
  • Unstable = pain at rest or increasing in severity/frequency
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6
Q

What two EKG changes are often indicative of subendocardial ischemia?

A
  • ST segment depression
  • Transient T-wave depression
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7
Q

What is the name of the point where the transition from the QRS to the ST-segment occurs?

A

J-Point

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8
Q

What are the three types of ST-Segment depression?

A
  • Up-sloping
  • Down-sloping
  • Horizontal
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9
Q

What type of ST-segment depression is most likely to be related to coronary disease?

A

Horizontal ST depression

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10
Q

More ST depression = ______ likelihood of significant CAD.

A

higher

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11
Q

What diagnostic test assesses coronary perfusion and has greater sensitivity for ischemia than exercise testing?

A

Nuclear stress test

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12
Q

Which tracers are used with nuclear stress testing?

A

Thallium & Technetium

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13
Q

What would an absent uptake of nuclear stress test tracers indicate?

A

Old MI (fibrous tissue)

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14
Q

What would an significant uptake of nuclear stress test tracers indicate?

A

normal circulation

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15
Q

What would a decreased uptake of nuclear stress test tracers indicate?

A

Perfusion abnormality

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16
Q

How is non-exercise nuclear stress testing done?

A

Induced tachycardia w/

  • Atropine
  • Dobutamine
  • Pacing
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17
Q

Which two drugs are coronary dilators used in nuclear stress testing?

A

Adenosine
Dipyridamole

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18
Q

What type of coronary plaque is considered unstable?

A

Large lipid core with thin cover

Very likely to rupture.

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19
Q

What does aspirin inhibit?

A

COX-1
Thromboxane A2

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20
Q

How long does the effect of platelet inhibition due to aspirin last?

A

For the life of the platelet (irreversible)

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21
Q

What is the “lifespan” of a human platelet?

A

7 - 10 days

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22
Q

How does Clopidogrel (Plavix) work?

A

Inhibition of ADP receptor (P2Y12)

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23
Q

What drug class can greatly change the effects of Plavix due to enzyme inhibition?

A

PPI’s

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24
Q

What drug is similar to clopidogrel in the following:

  • Requires P450 enzyme for conversion from prodrug to active metabolite
  • Inhibits ADP P2Y12
A

Prasugrel (Effient)

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25
Q

What are the pros & cons of Prasugrel vs Plavix?

A

Prasugrel Pros:

  • Rapidly absorbed
  • Faster onset
  • Less individual variability

Cons:

  • Higher risk of bleeding (much more potent)
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26
Q

What two conditions were mentioned in lecture as contraindications for nitrate administration?

A
  • Hypertrophic Cardiomyopathy
  • Aortic Stenosis
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27
Q

Nitrates have a synergistic effect with what drug classes?

A

β blockers & CCB’s

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28
Q

What are the effects of nitrates?

A
  • Subendocardial artery dilation
  • ↓ SVR
  • ↓ afterload
  • ↓ myocardial O₂ consumption
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29
Q

Which two cardiac disease processes necessitate a maintenance of a high afterload?

A
  • Hypertrophic Cardiomyopathy
  • Aortic Stenosis
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30
Q

Can nitrates be given around the clock?

A

No, 8 - 12 hours of the day need to be nitrate free.

Sensitization occurs w/ around the clock therapy.

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31
Q

What is the principal drug for stable angina?

A

β blockers

32
Q

How do β blockers improve coronary perfusion?

A
  • ↓ myocardial O₂ demand
  • ↑ diastole time
33
Q

In what scenarios are β blockers contraindicated?

A
  • Severe bradycardia
  • Sick sinus syndrome
  • Severe Asthma
  • 2ⁿᵈ & 3ʳᵈ degree heart block
  • Uncontrolled CHF
34
Q

What common cardiac drug class will mask the signs of hypoglycemia?

A

β blockers

35
Q

What are the SCIP protocol measures for β blockers?

A
  • If already on β blocker, must receive dose within 24 hours of surgery
  • If not on β blocker, do not initiate unless 1-4 weeks out from non-cardiac surgery.
36
Q

What type of calcium channels do CCB’s bind to?

A

L-type Ca⁺⁺ channels

37
Q

Where are the effects of L-type Ca⁺⁺ channel blockade seen?

A
  • Smooth muscle
  • Cardiac Myocytes
  • SA/AV nodes
38
Q

Are β blockers or CCB’s more effective in prevention of MI?

A

β blockers

39
Q

What type of angina are CCBs most useful for?

A

Prinzmetal’s Angina

40
Q

What is Prinzmetal’s angina?

A

Vasospasm related angina (not related to atherosclerosis)

41
Q

Angiotensin II promotes inflammatory response and what other deleterious cardiac effects?

A
  • Atheroma formation
  • Coronary vasoconstriction
  • Myocardial hypertrophy
42
Q

ACE inhibitors are indicated for patients with CAD and what other concurrent diseases?

A
  • HTN
  • LV dysfunction
  • DM
43
Q

What antihypertensive is held within 24 hours of anesthesia? Why?

A

ACE Inhibitors (compounds hypotension from anesthesia).

44
Q

What is the mortality of STEMI without early reperfusion therapy? How about with reperfusion therapy?

A
  • 20% without
  • 6.5% with reperfusion therapy
45
Q

What is MONA?

A

Morphine
Oxygen
Nitrates
Aspirin

46
Q

According to lecture, what is an NSTEMI?

A

No ST-elevation but:

  • New-onset severe and/or prolonged angina
  • Angina at rest for more than 20 min
47
Q

How are NSTEMI’s diagnosed?

A
  • ↑ biomarkers
  • ST depression and/or T-wave inversion w/ pain.
48
Q

What is the major difference in treatment of STEMI vs NSTEMI?

A

No thrombolytics (tPa) for NSTEMI patients

49
Q

What is the most common cause of death in acute MI?

A

Cardiac Dysrhythmias

50
Q

If ventricular tachycardia is asymptomatic, how can it be treated?

A

Lidocaine and/or amiodarone

51
Q

What are the most common atrial dysrhythmias?

A

Afib / Aflutter

52
Q

What decreases the occurrence of atrial dysrhythmias during/after MI?

A

Thrombolytics

53
Q

What type of MI is commonly seen with sinus bradycardia?

A

Inferior wall MI

54
Q

When does pericarditis typically occur after an MI?

A

1 - 4 days post MI

55
Q

What position worsens pericarditis pain?

A

Lying down

56
Q

Diffuse ST-segment changes would likely indicate ________.

A

Pericarditis

57
Q

How is pericarditis treated?

A
  • ASA
  • Indomethacin
  • Steroids
58
Q

If pericarditis becomes chronic after an MI, it is called ________ syndrome.

A

Dressler’s Syndrome

59
Q

What can occur from ischemic injury causing rupture of the papillary muscles?

A

Mitral regurgitation

60
Q

An MI in which wall makes mitral regurgitation much more likely?

A

Inferior wall MI (can result in papillary muscle rupture).

61
Q

What is the treatment for Mitral Regurgitation?

A
  • ↓ LV Afterload (diuretics, nitrates)
  • ↑ Coronary perfusion (IABP, consider valve repair)
62
Q

In order to have significant cardiogenic shock, usually ____ % or more of the myocardium must be infarcted.

A

40% or more

63
Q

Where is the tip of a IABP positioned?

A

Just below the Left Subclavian artery

64
Q

When does an IABP inflate & deflate?

A
  • Inflate during ventricular diastole
  • Deflate just prior to ventricular systole
65
Q

What are contraindications to IABP placement?

A
  • Severe aortic insufficiency
  • Aortic Aneurysm
  • Severe PAD
  • Severe Coagulopathy
66
Q

What are the possible complications of IABP?

A
  • Limb Ischemia
  • Aortic Dissection
  • Hemorrhage
  • Helium Emboli
  • Infection
67
Q

KNOW 12 LEAD EKG DIAGNOSES

68
Q

When are bare-metal coronary stents more appropriate than drug-eluting stents?

A

In patients who need urgent surgeries

69
Q

What is inhibited by drug-eluting stents?

A
  • Clotting
  • Neointimal Hyperplasia
70
Q

What makes drug-eluting stent placement much more risky?

A

If antiplatelet therapy is discontinued in 1st year

71
Q

What is the general risk with coronary stenting?

A
  • Mechanically opening a blood vessel injures the endothelium and increases the risk of thrombosis
72
Q

How long does re-endothelialization occur (according to current DAPT guidelines) with the following:

  • Angioplasty
  • Bare-metal stents
  • Drug-eluting stents
A
  • 2 weeks
  • 6 weeks
  • 3 months
73
Q

What pathologies have shown increased mortality in studies in patients who are who are on DAPT?

A
  • Spinal Cord pathologies
  • Aneurysm
  • Prostatectomy
74
Q

Look up DAPT & Neuraxial Interventions

75
Q

What are the indications for CABG surgery?

A
  • Medical therapy failure
  • LM > 50% obstructed
  • EF <40% w/ significant disease
  • 3 or more diseased vessels
76
Q

When is emergency CABG surgery indicated?

A
  • Failed angioplasty
  • MI septal rupture
  • MI mitral regurgitation
  • Perforated coronary artery
  • Cardiogenic shock

Advanced Principles C (11 decks)

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