Cardiovascular pathophysiology 6

Question 1

_____________ is the most common cause of postoperative death for AAA.

Answer 1

Myocardial infarction

Question 2

The classic triad of AAA rupture consists of

Answer 2

hypotension
back pain
pulsatile abdominal mass
only present in 50% of patients

Question 3

Independent risk factors for AAA include

Answer 3

cigarette smoking
male gender
advanced age

Question 4

___________ correlates with the risk of rupture

Answer 4

Diameter of the AAA

Question 5

What law is applied to aneurysms?

Answer 5

law of Laplace

Question 6

Most aneurysms rupture in the

Answer 6

left retroperitoneum

Question 7

Which factors increase following cross-clamp removal during abdominal aortic aneurysm repair? (select 2)
a. pulmonary vascular resistance
b. venous return
c. total body oxygen consumption
d. coronary blood flow

Answer 7

a. pulmonary vascular resistance
c. total body oxygen consumption

Question 8

Application of aortic cross-clamp creates _______________ by increasing _____________ & shifting a greater proportion of the blood volume _______ to the clamp

Answer 8

central hypervolemia; venous return; proximal

Question 9

How does aortic cross-clamp affect MAP, SVR, and SvO2?

Answer 9

increases all of them

Question 10

Clamping starves distal tissues of

Answer 10

oxygen so these cells convert to anaerobic metabolism

Question 11

____________ are washed into the systemic circulation when the clamp is released

Answer 11

Metabolic byproducts

Question 12

__________ is a minimally invasive approach of correcting an abdominal aortic aneurysm.

Answer 12

EVAR

Question 13

Removal of aortic cross-clamp creates ____________ by restoring venous capacity ad shifting blood to ___________

Answer 13

central hypovolemia; the lower body

Question 14

Compared to open aortic procedures, EVAR has several benefits including

Answer 14

shorter operative times
lower rate of transfusion
shorter length-of- stay
reduced morbidity

Question 15

______________ occurs when the original graft fails to prevent blood from entering the aortic sac

Answer 15

An endoleak

Question 16

The patient’s physiologic response to the aortic cross-clamp is related to 3 factors:

Answer 16

location of AoX placement (infrarenal most common)
intravascular volume status
cardiac reserve

Question 17

With an EVAR, the patient will receive

Answer 17

IV contrast dye so complications related to the dye must be considered

Question 18

Complications of EVAR include

Answer 18

activation of the baroreceptor reflex
massive hemorrhage
aortic rupture
cerebral embolism

Question 19

Occlusion of the artery of Adamkiewicz during thoracic aneurysm repair may result in all of the following EXCEPT:
a. flaccid paralysis of the lower extremities
b. bowel and bladder dysfunction
c. loss of proprioception
d. loss of temperature and pain sensation

Answer 19

c. loss of proprioception

Question 20

The most important radicular artery perfusing the anterior spinal cord in the thoracolumbar region is the

Answer 20

artery of Adamkiewicz

Question 21

Interruption of blood flow to the artery of Adamkiewicz can cause

Answer 21

ischemia or infarction to the corresponding spinal cord segments

Question 22

An aortic cross-clamp placed above the artery of Adamkiewicz can cause

Answer 22

ischemia to the lower portion of the anterior spinal cord

Question 23

Anterior spinal artery syndrome is also known as

Answer 23

Beck’s syndrome

Question 24

Symptoms of anterior spinal artery syndrome include

Answer 24

flaccid paralysis of the lower extremities
bowel and bladder dysfunction
loss of temperature and pain sensation

Question 25

Anesthetic considerations for aortic surgery include

Answer 25

thoracic cross-clamp times <30 minutes moderate hypothermia (30-32 degrees C) CSF drainage MAP ~100 mmHg avoidance of hyperglycemia SSEP & MEP monitoring partial CPB drugs- corticosteroids, CCBs, and/or mannitol

Question 26

Where does the artery of adamkiewicz originate?

Answer 26

typically between T8-12

Question 27

Injury to which spinal tract explains flaccid paralysis of the lower extremities?

Answer 27

corticospinal tract

Question 28

Injury to which spinal tract explains loss of pain and temperature sensation?

Answer 28

spinothalamic tract

Question 29

What is the BEST monitor of neurologic integrity during carotid endarterectomy? a. cerebral oximetry b. awake patient c. electroencephalography d. transcranial doppler

Answer 29

b. awake patient

Question 30

Patients with carotid stenosis are at higher risk of

Answer 30

transient ischemic attacks or stroke

Question 31

In symptomatic patients, CEA significantly reduces stroke risk when the degree of carotid stenosis exceeds

Answer 31

70%

Question 32

____________ is a sign of impending stroke.

Answer 32

Amaurosis fugax (temporary blindness in one eye)

Question 33

CEA can be performed under

Answer 33

regional or general anesthesia

Question 34

_________ is the best method to assess neurologic integrity

Answer 34

The awake patient

Question 35

______________ on the day of surgery has been associated with an increased risk of stroke and death.

Answer 35

Hyperglycemia (>200 mg/dL)

Question 36

During cross-clamping, how should BP be managed?

Answer 36

normal or slightly elevated BP

Question 37

After the cross-clamp is removed, how should BP be managed?

Answer 37

keep the SBP under 145 mmHg to reduce the risk of bleeding at the graft site

Question 38

Postoperative considerations of BP include

Answer 38

hematoma, RLN injury, labile BP, and stroke (most common embolic)

Question 39

What ACT is desired for carotid artery angioplasty stenting?

Answer 39

ACT >250 seconds

Question 40

Balloon inflation with carotid artery angioplasty stenting can activate the

Answer 40

baroreceptor reflex leading to bradycardia and hypotension- pretreat with atropine or glyco to attenuate this response

Question 41

Embolic stroke is treated with

Answer 41

recombinant tissue plasminogen activator

Question 42

In the patient with right subclavian steal syndrome, arterial flow is diverted from the: a. right vertebral artery to the right subclavian artery b. right subclavian artery to the left subclavian artery c. left vertebral artery to the right subclavian artery d. left subclavian artery to the right subclavian artery

Answer 42

a. right vertebral artery to the right subclavian artery

Question 43

Subclavian steal occurs when

Answer 43

there is an occlusion of the subclavian or innominate artery proximal to the origin of the ipsilateral vertebral artery

Question 44

The ___________ is much lower in the ipsilateral arm with subclavian steal syndrome

Answer 44

BP- pulse may be diminished

Question 45

The treatment of choice for subclavian steal syndrome is

Answer 45

subclavian endarterectomy

Question 46

Signs and symptoms of subclavian steal syndrome include

Answer 46

syncope vertigo ataxia hemiplegia ischemia to the ipsilateral arm upper extremity weak pulse

Question 47

Is subclavian steal syndrome more common on the left or right side?

Answer 47

left side

Question 48

Subclavian steal syndrome "steals" blood from which vessel?

Answer 48

vertebral artery