Cardiovascular Disease Flashcards
How are you going to monitor cardiac patients ?
ECG, indirect BP, ETCO2, temp
Invasive arterial BP in certain patients
Cardiac output monitoring may be available in certain situations
External pacing device with ECG for 3rd degree AV block
What is the difference between hypovolemic and septic shock?
Hypovolemic —> decreased preload
Septic -> decreased preload due vasodilation, and decreased contractility due to inflammatory mediators
What are the indications for treating ventricular premature complexes?
Rate > 180
R on T phenomenon
Multiform
Causing hypotension
You have a patient in shock, what pre-operative treatments will you do?
Adequate fluid resuscitation with appropriate fluids
-> hemoabdomen may require blood products before/during procedure
Correct severe hypoglycemia or hypocalcemia (common in septic patients)
Analgesics
HR should be 120-140 and BP should be >90 prior to induction
What drugs are you going to avoid in shock patients?
Phenothiazines > vasodilation and decrease BP
A2 agonsit > vasoconstriction and bradycardia
Propofol > vasodilation, decreased contractility
Pre-op atropine > tachycardia (can use intra op for bradycardia)
What drugs can be used in shock patients??
Opioids and benzo -> reversible with minimal CV effects
Etomidate and alfaxalone -> minimal CV effects
Ketamine -> mild CV stimulation
How do you manage intra-operative hypotension in shock patient ?
Keep inhalant anesthetic as low as possible
Multi-modal therap - opioid, lidocaine, ketamine, benzo
Fluids
- crystalloid +/- colloid
- hypertonic NaCl
Vasopressor and inotropes
What is drug therapy for vasodilation ?
Dopamine
Norepi
Ephedrine
Vasopressin
What are your drug therapies for poor inotropy ?
Dobutamine
Dopamine
What dogs commonly have mitral valve disease?
Older small breed dog
CKCS
Your giving your mitral valve disease patient diuretics, ACE inhibits, and pimobdenan to control CHF. Which one of these should be withheld the morning of surgery and why?
ACE inhibitors
Avoid refractory hypotension
This goes for any patient that has CHF (eg same in DCM dog)
What type of fluids may be more appropriate for increasing vascular volume in a patient with mitral valve disease?
Colloids
Patients do not tolerate excess IV fluids —> CHF (pulmonary edema)
Crystalloids can redistribute causing more edema
What drugs do you AVOID in patients with mitral valve disease?
Phenothiazines > vasodilation
A2 agonsit > increase afterload
Propofol >vasodilation
Pre op atropine > tachycardia
What drugs do you use in mitral valve disease
Opioid and benzo
Etomidate/ alfaxalone
Ketamine (except with pre-existing tachycardia)
Dobutamine or dopamine for hypotension
Dilated cardiomyopathy results in _________ dysfunction
Systolic
The enlarged right atrium in DCM predisposes animals to what type arrhythmia?
Atrial fibrillation
What drugs can be used in DCM?
Opioid and benzo
Alfaxalone and etomidate
Dobutamine and dopamine for hypotension
When do you want to avoid ketamine in DCM?
If atrial fibrillation or sinus tachycardia is present
What breed of cats commonly get hypertrophic cardiomyopathy?
Maine coon
HCM can lead to CHF, how should this be treated prior to anesthesia?
Diuretics, ACE inhibitors
Thoracocentesis - under sedation like butorphanol and benzo
What drugs can we use in our HCM cats?
Opioid and benzo
Alfaxalone and etomidate
Dopamine preferred for hypotension
What is a shunt form L -> R, aorta to pulmonary artery?
Patent ductus arteriosus (PDA)
PDA causes a volume overload to the _______ side of the heart resulting in what type of remodeling?
Left
Eccentric hypertrophy
What are the options for PDA treatment??
Surgical: thoracotomy with PDA ligation
Coil occlusion
At the time of PDA occlusion, diastolic BP will increase dramatically. How does this affect HR and how do you treat this?
Result if reflex bradycardia
Treat with atropine
What drugs can you use during PDA surgery?
Opioid and benzo
Alfaxalone, etomidate, profofol and ketamine
Pre-anesthetic anticholinergic
Locoregional anesthetic for thoracotomy (intercostal blocka Nd intrathoracic local anesthesia +/- morphine epidural)
Pulmonic stenosis causes increased pressure of the _________ ventricle, resulting in what type of cardiac remodeling?
Right
Hypertrophy
How is pulmonic stenosis treated?
Balloon valvuloplasty
What are you going to be cautious about during pulmonic stenosis surgery?
Avoid excessive fluid administration
Maintain HR
Ready to treat ventricular arrhythmia
What clinical signs can result due to 3rd degree AV block?
Syncope and exercise intolerance
HR is usually 30-40bpm
T/F: patients with 3rd degree AV block should not be anesthetized unless for pacemaker placement or life-threatening emergency
True
How is HR maintained in patients with 3rd degree AV block during anesthesia?
Pacemaker
- transcutaneous
- temporary transvenous
The permanent pacemaker can be placed trans-diaphragmatic through the jugular vein with fluoroscopic guidance
What drugs should you absolutely avoid in 3rd degree AV block?
any that cause vagal simulation, bradycardia, or hypotension
- a2 agonsit
- acepromazine
- pure mu (can cause vagal stim)
What drugs CAN be used during pacemaker placement for 3rd degree Av block?
Anticholinergic
Butorphanol and benzo
Ketamine (might help increase HR)
Etomidate or alfaxalone
Local anesthetics
T/F: an accelerated idioventricular rhythm will respond to lidocaine
Nope
What are the 3 arrest rhythms ?
Ventricular fibrillation
Asystole
Pulseless electrical activity
