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Cards Flashcards

1
Q

Goal of targeted temperature management for in hospital cardiac arrests?

A

Normothermia

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2
Q

Indications for aortic valve replacement?

A

Normal aortic valve area is 3-4 cm2

AV replacement should be performed electively once symptoms of angina or syncope occur

Asymptomatic pts with valve area < 1 cm2 are also candidates for repair

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3
Q

Tx of unstable Afib?

A

Synchronized cardioversion

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4
Q

Atropine dose symptomatic bradycardia?

A

1 mg every 3-5 mins

Max 3 mg

If ineffective consider trascutaneous pacing, if still symptomatic needs transvenous pacing

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5
Q

Contraindication to IABP?

A

Aortic regurgitation

Becomes worse when balloon is inflated

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6
Q

Type I HIT?

A

Non-immune mediated thrombocytopenia occurring 1-2 days after heparin exposure
Heparin causes the platelets to aggregate together

Does not increase thrombotic risk and discontinuation of heparin not necessary

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7
Q

Type II HIT?

A

Immune mediated reaction mediated by autoantibodies to Platelet Factor IV

Seen 5-14 days after heparin exposure

Less common than HIT I

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8
Q

4T test to assess probability of HIT:

A

Timing
Thrombocytopenia
Thromboembolic events
Other causes of thrombocytopenia

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9
Q

Approved drug to use once HIT II detected?

A

Stop heparin and switch to argatroban

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10
Q

MOA of milrinone;

A

Phosphodiesterase inhibitor

Half life 2-4 hrs

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11
Q

MOA of vasopressin;

A

Made by posterior pit

V1 receptors on vascular smooth muscle—> leads to vasoconstriction and increased SVR
V2 receptors in kidney tubules —> increase fluid reabsorption

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12
Q

Where is IABP placed?

A

Descending thoracic aorta

Inflation of the balloon occurs during diastole; right after AV closes
Deflation occurs right before AV opening and LV ejection

Cycles of inflation and deflation are synced to patient’s own heartbeat in a 1:1 or 1:2 ratio, meaning the balloon augments each beat or every other beat

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13
Q

Indications for IABP placement:

A

Bridge to heart tx
Augmentation of heart during PCI
Cardiogenic shock after MI
Refractory heart failure
Unstable angina
Intractable arrhythmia

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14
Q

Benefits of IABp during diastole v systole’

A

Inflation during Diastole; augments diastolic and aortic root pressure

Deflation during systole; decreased end-diastolic aortic root pressure, decreased after load, LV wall stress, and myocardial oxygen demand, increases stroke volume and CO

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15
Q

Absolute contraindications to IABP:

A

Aortic regurgitation
Aortic dissection
Aortic aneurysms

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16
Q

Impella?

A

Continuous flow axial pump, used for temporary hemodynamic support

Catheter mounted pump draws blood into the catheter and pumps it forward

Impella 2.5, 5, LD, CP all support the help heart, with inflow in the LV and outflow in the aorta

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17
Q

Impella 5?

A

Needs a vascular cutdown to be placed

Impella 2.5 and CD can be placed percutaneously vie femoral or axillary artery

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18
Q

How is the Impella LD placed?

A

Sternotomy and thoracotomy

Placed directly into the ascending aorta

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19
Q

What does the Impella RV do?

A

Supports RV

Inflow placed in the IVC, outflow in the pulmonary artery

Can be placed percutaneously

20
Q

Benefits of Impella devices?

A

Augment forward flow, increasing CO, and coronary and end organ perfusion

Unload blood for LV reducing LV stress and end-diastolic volume, reduced LV wall tension and myocardial oxygen demand

21
Q

Contraindications for Impella placement?

A

Aortic insufficiency
LV thrombus
Recent stroke, TIA
Inability to anticoagulate
Severe PVD

22
Q

Indications for Impella?

A

Temporary < 6 hr support during PCI (Impella 2.5)
14 day assist for acute right heart failure (Impella RP)

23
Q

Tandemheart?

A

Continuous flow ventricular assist device

Directs blood from Left Atrium to systemic circulation

Inflow is inserted in right atrium via femoral vein access and placed into left atrium via transseptal approach
Outflow is then placed into femoral artery

24
Q

Benefits of tandem heart?

A

Improves CO and MAP

Decreases PCWP, LA pressure, CVP pressure, pulmonary artery pressure

25
Q

Contraindications to Tandem heart placement?

A

Aortic insufficiency
Atrial thrombi
VSD
Inability to anticoagulate
PVD

26
Q

Centrimag?

A

Surgically placed, short term, ventricular assist device used for LV/RV or biventricular support

For LV: inflow is in LV, outflow is in ascending aorta
For RV: inflow is in RV, outflow is in pulm artery

27
Q

Indications for permanent LVAD placement?

A

Bridge to heart transplant
Pts who are not eligible for heart transplant
Bridge to a decision

28
Q

REMATCH trial?

A

Showed superiority of LVADs over medical therapy for heart failure

29
Q

What are two LVADs used today?

A

HeartMate
Heart Ware HVAD

30
Q

What is flow pulsatility in LVAD devices?

A

Flow pulsatility measure native LV function as it pumps some blood into the LVAD device as well as into native circulation

31
Q

Contraindications to LVADs?

A

Advanced Hepatic dysfunction
Active malignancy
Kidney dysfunction
Severe COPD
Systemic illness that limits life expectancy beyond two years

32
Q

Syncardia Total artificial heart?

A

Patients native valves and ventricles are replaced by a mechanical alternative

Used for patients with biventricular failure as bridge to transplant

33
Q

How to calculate MAP?

A

DBP + 1/3 (SBP-DBP)

34
Q

Pulse pressure?

A

Systolic - Diastolic

35
Q

Cardiac index?

A

CO/BSA

2.5-4 L is normal

36
Q

Causes of PEA arrest; H/Ts;

A

Hs: hypotension, hypoglycemia, hypoxia, hypo/hyperkalemia, hypothermia, acidosis

Ts; tension ptx, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis

37
Q

Minimal chest compression fraction associated with improved survival?

A

Try to minimize chest compression and breaths as much as possible

A chest compression of at least 60-80% has been shown to provide best outcomes

38
Q

Greatest mortality risk with out of hospital cardiac arrest 2/2?

A

Unwitnessed arrests without bystander CPR often occurring at night in the elderly

39
Q

Highest predictor of survival for in and out of hospital CPR?

A

Witnessed arrests with rapid bystander CPR initiated and initial SHOCKABLE rhythm such as vfib or pulse less Vtach

40
Q

Pregnant woman suffers cardiac arrest, what’s been shown to achieve ROSC the greatest?

A

C-section delivery of the baby

Ideally within 10 minutes of CPR

41
Q

Shift of oxygen curve to the right?

A

Favors unloading of oxygen to tissue

The hemoglobin molecule has less affinity of O2

42
Q

What does CO do the oxygen hemoglobin dissociation curve?

A

Shift its to the left

43
Q

CaO2?

A

CaO2 = (1.34 x Hgb x O2 sat) + (0.003 x PaO2)

44
Q

Single biggest factor for oxygen content in the CaO2 formula:

A

Hemoglobin

Doubling the hemoglobin will double the oxygen content

CaO2 = (1.34 x hgb x O2 Sat) + (0.003 x PaO2)

45
Q

The constant 1.34 in the CaO2 formula represents what?

A

Amount of oxygen that 1 g of hemoglobin carries at 1 atm of pressure

46
Q

The least influential parameter to oxygen content in the CaO2 formula?

A

Dissolved oxygen

(0.003 x PaO2)

SCC (9 decks)

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