Cardiovascular pathophysiology 5 Flashcards
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
c. it inflates during diastole
d. it is contraindicated in severe aortic insufficiency
The intra-aortic balloon pump improves
the balance between myocardial oxygen supply and demand
Indications of the intra-aortic balloon pump include
cardiogenic shock
myocardial infarction
intractable angina
difficult separation from CPB
The intra-aortic balloon inflates during_____________. This augments __________
diastole; coronary perfusion
The balloon deflates during _______________. This causes a vacuum-like effect that ______________
systole; reduces afterload and reduces left ventricular work
The most common complications of IABP include
vascular injury
infection at the insertion site
thrombocytopenia
The balloon can be timed to inflate during
every cardiac cycle (1:1) or at some other ratio (1:2, 1:3, etc.) to facilitate weaning
Contraindications to an intra-aortic balloon pump include
severe aortic insufficiency
descending aortic disease (aneurysm)
severe peripheral vascular disease
sepsis
How is an intra-aortic balloon pump inserted?
through the femoral artery and advanced along the descending aorta
Proper position of the intra-aortic balloon pump is confirmed with
CXR, fluoroscopy, or TEE
The tip of the balloon pump should be positioned
2 cm distal to the left subclavian artery- more proximal can lead to occlusion of the left common carotid and/or brachiocephalic arteries
Patients on long term IABP therapy require
anticoagulation
In the patient with a left ventricular assist device, organ perfusion is LEAST dependent on:
a. preload
b. pump speed
c. afterload
d. inotropy
d. inotropy
An LVAD is a mechanical device that
unloads the failing heart by pumping blood from the left ventricle to the aorta
An LVAD can be used as a bridge to
recovery
transplant
or destination therapy
________ is the most common cause of death with an LVAD.
Sepsis
______________ anesthesia is avoided with an LVAD because
regional; on anticoagulant medications
Pump flow for an LVAD is highly dependent on
adequate LV preload
pump speed (RPMs)
and the pressure gradient across the pump (afterload)
Flow with an LVAD can be
pulsatile or non-pulatile
Considerations if blood flow is non-pulsatile.
SpO2 & NIBP will be ineffective
consider an arterial line, serial ABGs, and cerebral oximetry