Cardiovascular pathophysiology 5

Question 1

Pick the statements that MOST accurately describe an intra-aortic balloon pump. (select 2)
a. it increases afterload
b. the tip of the balloon should be positioned 2 cm proximal to the brachiocephalic artery
c. it inflates during diastole
d. it is contraindicated in severe aortic insufficiency

Answer 1

c. it inflates during diastole
d. it is contraindicated in severe aortic insufficiency

Question 2

The intra-aortic balloon pump improves

Answer 2

the balance between myocardial oxygen supply and demand

Question 3

Indications of the intra-aortic balloon pump include

Answer 3

cardiogenic shock
myocardial infarction
intractable angina
difficult separation from CPB

Question 4

The intra-aortic balloon inflates during_____________. This augments __________

Answer 4

diastole; coronary perfusion

Question 5

The balloon deflates during _______________. This causes a vacuum-like effect that ______________

Answer 5

systole; reduces afterload and reduces left ventricular work

Question 6

The most common complications of IABP include

Answer 6

vascular injury
infection at the insertion site
thrombocytopenia

Question 7

The balloon can be timed to inflate during

Answer 7

every cardiac cycle (1:1) or at some other ratio (1:2, 1:3, etc.) to facilitate weaning

Question 8

Contraindications to an intra-aortic balloon pump include

Answer 8

severe aortic insufficiency
descending aortic disease (aneurysm)
severe peripheral vascular disease
sepsis

Question 9

How is an intra-aortic balloon pump inserted?

Answer 9

through the femoral artery and advanced along the descending aorta

Question 10

Proper position of the intra-aortic balloon pump is confirmed with

Answer 10

CXR, fluoroscopy, or TEE

Question 11

The tip of the balloon pump should be positioned

Answer 11

2 cm distal to the left subclavian artery- more proximal can lead to occlusion of the left common carotid and/or brachiocephalic arteries

Question 12

Patients on long term IABP therapy require

Answer 12

anticoagulation

Question 13

In the patient with a left ventricular assist device, organ perfusion is LEAST dependent on:
a. preload
b. pump speed
c. afterload
d. inotropy

Answer 13

d. inotropy

Question 14

An LVAD is a mechanical device that

Answer 14

unloads the failing heart by pumping blood from the left ventricle to the aorta

Question 15

An LVAD can be used as a bridge to

Answer 15

recovery
transplant
or destination therapy

Question 16

________ is the most common cause of death with an LVAD.

Answer 16

Sepsis

Question 17

______________ anesthesia is avoided with an LVAD because

Answer 17

regional; on anticoagulant medications

Question 18

Pump flow for an LVAD is highly dependent on

Answer 18

adequate LV preload
pump speed (RPMs)
and the pressure gradient across the pump (afterload)

Question 19

Flow with an LVAD can be

Answer 19

pulsatile or non-pulatile

Question 20

Considerations if blood flow is non-pulsatile.

Answer 20

SpO2 & NIBP will be ineffective
consider an arterial line, serial ABGs, and cerebral oximetry

Question 21

The inflow cannula of a LVAD is inserted into

Answer 21

the apex of the left ventricle

Question 22

The presence of the ____________, ______________, or ___________– requires a surgical correction before an LVAD can be placed

Answer 22

intracardiac shunt (PFO), aortic insufficiency, or tricuspid regurgitation

Question 23

Mechanical shear stress with an LVAD can cause

Answer 23

coagulopathy & platelet dysfunction

Question 24

_________ is common with a LVAD.

Answer 24

GI bleeding

Question 25

Optimization of ___________ is critical because an imbalance between _________ and pump speed can lead to complications

Answer 25

intravascular volume; preload

Question 26

The combination of low preload and a relatively high pump speed can produce

Answer 26

a suction event (LV sucks down) and occludes the inflow cannula

Question 27

Consequences of a suction event include

Answer 27

hypotension ventricular dysrhythmias

Question 28

What is the primary treatment for a "suck down" event?

Answer 28

IVF reduce pump speed

Question 29

The Crawford classification classifies aortic aneurysms into four types based on

Answer 29

the aneurysm's involvement in the thoracic and abdominal aorta

Question 30

What aneurysm types are the most difficult to repair?

Answer 30

Crawford type 2 and 3 b/c they involve the thoracic and abdominal aorta

Question 31

Crawford type 2 aneurysms present the most significant

Answer 31

perioperative risks including paraplegia and renal failure following surgery

Question 32

The _______ & _____________- classifications classify various aortic dissections

Answer 32

DeBakey & Stanford

Question 33

_________ dissection of the _______________ is a surgical emergency

Answer 33

Acute dissection of the ascending aorta (DeBakey 1 or 2 or Stanford A)

Question 34

Which valve is often affected with acute dissection of the ascending aorta?

Answer 34

aortic valve- aortic insufficiency

Question 35

Type 1 Crawford aortic aneurysm involves

Answer 35

all or most of the descending thoracic aorta and upper only of the abdominal aorta

Question 36

Type 2 Crawford involves

Answer 36

all or most of the descending thoracic aorta most of the abdominal aorta

Question 37

Type 3 Crawford involves

Answer 37

lower only of the descending thoracic aorta most of the abdominal aorta

Question 38

Type 4 Crawford involves

Answer 38

none of the descending thoracic aorta most of the abdominal aorta

Question 39

The Stanford type A is the same as the

Answer 39

Debakey Type 1 & 2

Question 40

The DeBakey Type 1 involves a tear in the

Answer 40

ascending aorta + dissection along entire aorta

Question 41

The DeBakey Type 2 involves a tear in the

Answer 41

ascending aorta + dissection only in ascending aorta

Question 42

The DeBakey Type 3 involves

Answer 42

a tear in proximal descending aorta

Question 43

Dissection of the descending aorta is often managed

Answer 43

medically (meds for HR, BP, pain) as surgical repair does not always produce a significant benefit

Question 44

Identify the statement that BEST describes perioperative considerations in the patient with an abdominal aortic aneurysm. (select 2) a. surgical intervention is recommended when the diameter is >5.5 cm b. Risk of aneurysmal rupture is best described by Poiseuille's Law c. it is more common in females d. back pain and hypotension suggest rupture

Answer 44

a. surgical intervention is recommended when the diameter is >5.5 cm d. back pain and hypotension suggest rupture

Question 45

Independent risk factors for AAA include

Answer 45

cigarette smoking gender (male >female) advanced age

Question 46

AAA is generally

Answer 46

symptomless

Question 47

AAA is most commonly detected as a

Answer 47

pulsatile abdominal mass during routine examination

Question 48

What is used to determine the size of a AAA?

Answer 48

CT US MRI

Question 49

Surgical correction is recommended when the aneurysm exceeds

Answer 49

5.5 cm or if it grows more than 0.6-0.8 cm per year

Question 50

The mechanisms for the development of AAA are the

Answer 50

destruction of elastin & collagen (primary) inflammation endothelial dysfunction platelet activation atherosclerosis