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apex review > Cardiovascular pathophysiology > Flashcards

Cardiovascular pathophysiology Flashcards

1
Q

Which surgical procedure presents the HIGHEST risk of cardiovascular morbidity and mortality for the patient with coronary artery disease?
a. open reduction and internal fixation of a femur fracture
b. video-assisted lung thoracoscopy
c. open abdominal aortic aneurysm repair
d. carotid endarterectomy

A

c. open abdominal aortic aneurysm repair

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2
Q

You can stratify cardiac risk with the patient’s

A

history & type of surgery

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3
Q

Surgical procedures associated with the highest cardiac risk include

A

emergency surgery
open aortic surgery
peripheral vascular surgery
long surgical procedures with significant volume shifts and blood loss

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4
Q

Patient-related conditions that increase cardiac risk include

A

a history of ischemic heart disease
CHF
cerebrovascular disease
DM
serum creatinine >2 mg/dL

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5
Q

If a patient had a recent MI, then the risk of reinfarction is greatest within

A

30 days of the event

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6
Q

After a recent MI, elective surgery should be delayed for

A

4-6 weeks

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7
Q

Cardiac risk is defined as

A

perioperative MI, CHF, and death

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8
Q

A patient with ____________ should be optimized before elective non-cardiac surgery.

A

unstable angina

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9
Q

The following surgeries put the patient at intermediate cardiac risk:

A

carotid endarterectomy
head & neck surgery
intrathoracic or intraperitoneal surgery
orthopedic surgery
prostate surgery

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10
Q

What is the NYHA classification of heart failure?

A

four classes that help to classify the extent of heart failure symptoms during activity

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11
Q

NYHA class 1 is

A

no symptoms with physical activity

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12
Q

NYHA class 2 is

A

symptoms appear during normal activity but no symptoms at rest

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13
Q

NYHA class 3 is

A

symptoms appear with less than normal activity but no symptoms at rest

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14
Q

NYHA class 4 is

A

symptoms appear with minimal activity or even at rest

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15
Q

What is the risk of perioperative MI if the patient had an MI <3 months ago?

A

30%

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16
Q

What is the risk of perioperative MI in the general population?

A

0.3%

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17
Q

Use the data set to calculate the coronary perfusion pressure.
HR= 50 bpm
Systolic BP= 100 mmHg
diastolic BP= 55 mmHg
pulmonary artery occlusion pressure= 15 mmHg
central venous pressure= 10 mmHg

A

40
CPP= Aortic diastolic pressure- LVEDP or in this case DBP- PAOP

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18
Q

Most MIs occur within ________ after surgery

A

48 hours

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19
Q

Which lead is best for monitoring dysrhythmias?

A

II

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20
Q

The treatment for intraoperative myocardial ischemia should focus on

A

interventions that make the heart slower, smaller, and better perfused

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21
Q

Myocardial oxygen balance is determined by the ratio of

A

oxygen supply relative to demand

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22
Q

The myocardium is at risk when the

A

supply is less than the demand

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23
Q

Factors that reduce myocardial oxygen supply include, but are not limited to,

A

tachycardia, hypoxemia, anemia, and a left shift of the oxyhemoglobin curve

24
Q

Factors that increase myocardial oxygen demand include

A

tachycardia
hypertension
SNS stimulation
increased wall tension
increased preload
increased afterload
increased contracitlity

25
Q

Myocardial injury and infarction injure the ___________, and disruption of this structure allows ______________

A

sarcolemma; intracellular proteins (CK-MB, Troponin-I, troponin-T) to enter the systemic circulation

26
Q

Infarcted myocardium releases which three important biomarkers?

A

CK-MB, troponin I, troponin T

27
Q

________________ are more sensitive than _________ for the diagnosis of myocardial infarction

A

Cardiac troponins; CK-MB

28
Q

Lead II aids in the identification of ____________ ischemia

A

inferior wall

29
Q

Which leads are best for detecting LV ischemia?

A

V3, V4, & V5

30
Q

What is the intervention for increased O2 demand?

A

beta blocker to a HR < 80 bpm
increased depth of anesthesia, vasodilator
nitroglycerin

31
Q

What is the intervention for decreased O2 supply?

A

anticholinergic, pacing
vasoconstrictor, reduce depth of anesthesia
nitroglycerin, inotrope

32
Q

We can assess ventricular compliance by evaluating

A

ventricular pressure at a given ventricular volume

33
Q

Co-existing condition that lead to diastolic dysfunction include

A

age >60 years
myocardial ischemia
hypertension
aortic stenosis

34
Q

If the patient has diastolic dysfunction, _____________ are required to prime the ventricle

A

higher filling pressure

35
Q

In the case of diastolic dysfunction, _____________ & ______________ will overestimate ventricular filling pressures

A

CVP & PAOP

36
Q

Compliance is decreased by conditions that make the heart

A

“stiffer”

37
Q

Elevated filling pressures put patients at higher risk of

A

pulmonary edema

38
Q

_______________ & ______________ are critically important to maintain the priming function.

A

Preservation of NSR and atrial kick

39
Q

Compliance is increased by conditions that

A

dilate the heart

40
Q

Clinical examples of conditions that increase compliance include

A

chronic aortic insufficiency
dilated cardiomyopathy

41
Q

Identify a compensatory mechanism in the patient with congestive heart failure.
a. decreased brain natriuretic peptide
b. decreased left ventricular end-diastolic pressure
c. increased renal blood flow
d. increased sympathetic tone

A

d. increased sympathetic tone

42
Q

Heart failure occurs when the myocardium is

A

unable to pump enough blood to satisfy the body’s metabolic demand

43
Q

Heart failure with reduced ejection fraction represents

A

a pump problem

44
Q

Examples of heart failure with reduced ejection fraction include

A

myocardial ischemia
valve insufficiency
dilated cardiomyopathy

45
Q

Anesthetic management of the patient with heart failure with reduced EF includes

A

lowering afterload
increasing contractility

46
Q

_____________ is the most common cause of right heart failure.

A

Left heart failure

47
Q

Conditions that increase PVR include

A

hypoxia, hypercarbia, acidosis, hypothermia, high PEEP, and nitrous oxide

48
Q

Heart failure with preserved ejection fraction (HFpEF or diastolic failure) represents a

A

filling problem

49
Q

The patient with HFpEF experiences

A

s/sx of HF but has a normal ejection fraction

50
Q

Examples of HFpEF include

A

myocardial ischemia
valve stenosis
hypertrophic cardiomyopathy
hypertension
cor pulmonale
obesity

51
Q

Anesthetic management for heart failure includes

A

maintaining a higher afterload and slowing the heart rate

52
Q

Compensatory mechanisms for heart failure include

A

chronic SNS activation
down-regulation of beta receptors
cardiac remodeling

53
Q

Treatment of right ventricular failure includes

A

inotropes- milrinone, dobutamine
pulmonary vasodilators- inhaled nitric oxide or sildenafil (PDE-5 inhibitor)
reversing causes of increased PVR

54
Q

List 4 physiologic adaptations to heart failure.

A

sns activation
excessive vasoconstriction
fluid retention
myocardial remodeling

55
Q

List 3 physiologic functions of BNP.

A

natriuresis
diuresis
vasodilation

apex review (224 decks)

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