CT Flashcards
Coronary venous position in relation to artery ?
Ant cardiac vein - RCA
Great cardiac vein - LAD
Middle cardiac vein - PDA (from RCA)
Pulmonary vein stenosis is a risk with … ablation therapy for AF
Radio frequency > cryotherapy (however cryo has more recurrence rate of arrhythmias)
IJ placement marks?
Between 2 heads of SCM just sup to clavicle with needle directed toward ipsilateral nipple
Normal CVP tracing summary
a -> c -> x -> v -> y
a wave: (A)trial contraction, absent in atrial fibrillation
c wave: (C)losure of TV.
bulging into RA during RV isovolumetric contraction
x descent: rela(X)action of RA.
TV descends into RV with ventricular ejection and atrial relaxation
v wave: (V)illing or filling of the RA
y descent: atrial empt(Y)ing into RV through open TV
High risk conditions for infective endocarditis are who should receive prophylaxis before dental, respiratory mucosa, or procedure involving infected skin
prosthetic cardiac valves,
history of infective endocarditis
unrepaired cyanotic CHD
completely repaired congenital heart defect during the first 6 months after the procedure
repaired CHD with residual defects at or adjacent to the site of prosthetic material
cardiac transplantation recipients with cardiac valvular disease.
The goal for general anesthesia induction in the patient with cardiac tamponade is to
keep the heart fast (quick heart rate), full (maximize preload by maintain spontaneous ventilation and avoiding PEEP), and forward (avoiding cardiac depressants).
Would you choice Katamine or propofol as induction agent for cardiac tamponade patients?
Propofol leads to decreased venous and systemic pressures in addition to exhibiting some myocardial depressant effects. Further, it blunts the baroreceptor reflex and would not allow for increased heart rate as a physiologic response.
Ketamine is the drug of choice for cardiac tamponade induction. Its maintenance of spontaneous ventilation and sympathomimetic effects without compromising hemodynamic goals make it the ideal agent for induction of general anesthesia for a patient in acute cardiac tamponade.
Blood supply to anterior and (anterio)septal LV?
LAD
Blood supply to inferior, (inferio)lateral, and (inferio)septal of LV?
RCA, (the septum spllied by LAD, so here the inferioseptal supplied by LAD and RCA).
Blood supply to inferio(lateral) and Anterio(lateral) of LV?
LCx artery. (remember the inferior side of LV supplied by RCA, so here the inferiolateral supplied by both RCA and LCx).
where is the site of radio-frequency ablation for atrial flutter?
isthmus between IVC and tricuspid annulus (caivotricuspid isthmus)
Alpha-star vs pH-stat blood gas management
Alpha maintains normocarbia and normal pH based on the assumption that the patient is 37 C
pH-stat maintains normocarbia and normal pH based on actual temp of patient
So in pH-stat management the CPB circuit infuses CO2 into the blood to maintain normal pHat whatever the Temp. (The increase CO2 causes increase CBF)
When is the left ventricular get refused ?
During diastole when aortic diastolic pressure is higher then LVEDP (preload)
The most sensitive lead for arrhythmia? And what’s for ischemi
Lead 2 and V4
For ischemi V5
For patient with post MI and intervention, when elective surgery can be done?
After medical management-> wait 30 days
If bare metal -> 30 days
If drug Eluting -> 6 months
After balloonplasty?
IE ppx antibiotics for ?
Undergoing; gingival, RS, or prosthetic valve procedure.
Other would be …
Prosthetic valves
Previous IE
Valvulopathy in transplanted heart
CHD (unrepaired cynotic, residual defect, or who have prosthetic material during the first 6 months after procedure)
GU or GI procedure if there is active infection, or procedure on infected skin/muscle
ARDS Treatment goal
The goal is to sustain the partial pressure of arterial oxygen at 55-80 mm Hg or the oxygen saturation at 88%-95% while also maintaining:
Low tidal volumes at 6-8 mL/kg predicted weight
Respiratory rate <35/min
Plateau pressure <30 cm H2O
Fraction of inspired oxygen (FiO2) <60%
Landmark of line placement for
IJV
Femoral vein
Subclavian vein
IJV:
Btw stern also and clavicular heads of SCM muscle. The JIV is lateral to carotid artery.
Femoral vein:
Medial to the femoral artery at the femoral crease
Subclavian vein:
Midpoint of clavicle with needle directed towards the suprasternal notch.
The RV is perfused during …
both systole and diastole whereas the LV is perfused during diastole only.
Right sided coronary vs left sided coronary perfusion pressure equals too?
Right-sided coronary perfusion pressure during systole is equal to the difference between aortic systolic pressure and RVEDP.
Right-sided coronary perfusion pressure during diastole is equal to the difference between aortic diastolic pressure and RVEDP.
and because the LV prefused during diastole, left-sided coronary perfusion pressure is the difference between aortic diastolic pressure and left ventricular end-diastolic pressure (LVEDP).
Coronary perfusion pressure is improved by REDUCING both RVEDP and LVEDP.
What medications should be avoided in SVT due to WPW?
Atrioventricular (AV) nodal blocking agents should be avoided as they increase conduction through the accessory pathway that may lead to ventricular fibrillation and subsequent cardiac arrest.
Can be safely managed with procainamide.
Maneuvers reduces the shear force exerted on the stent-graft during deployment are ?
To avoid the windsock effect, hypotension, rapid ventricular pacing, or transient asystole can be employed.
What shift expected of Positive lusitropy results on the myocardial pressure-volume loop.
Positive lusitropy results in a rightward shift of the diastolic filling phase on the myocardial pressure-volume loop. This results in increased CPP, LVEDV, and SV.
The following diagnoses should be considered in patients with a large R wave in lead V1:
1) Right ventricular hypertrophy
2) Posterior wall MI
3) Wolff-Parkinson-White syndrome
4) Muscular dystrophy
5) Right atrial enlargement
6) Right ventricular strain with ST-T wave abnormalities
