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Patho II > CV Disease Pt 1 > Flashcards

CV Disease Pt 1 Flashcards

1
Q

Coronary Perfusion Pressure = ?

A

Arterial diastolic pressure - LVEDP (is 5% of CO or 250ml/min)

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2
Q

Maximum coronary flow occurs during _____

A

Diastole

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3
Q

Auto regulation is between ______ mmHg

A

50-120

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4
Q

Concentric hypertrophy is d/t?

A

Chronically elevated afterload (pressure overload)

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5
Q

Eccentric hypertrophy is d/t?

A

Chronically elevated preload (volume overload)

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6
Q

Beginning of contraction, heart is as big as it gets.
Shows EDPVR & LVEDV where pressure is fairly low.
Indicates compliance

A

Point B

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7
Q

Ventricle starts relaxing. Ca is releasing from troponin and going back to SR. Shows ESPVR/ regurgitation

A

Point D

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8
Q

NYHA Classification of heart disease

A

I. Asymptomatic;
II. Symptoms with ordinary activity, no symptom at rest;
III. Symptoms with minimal activity, no symptoms as rest;
IV. Symptoms at rest

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9
Q

LA pressure in mitral stenosis

A

25/14

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10
Q

PE mitral stenosis

A

Opening snap, diastolic murmur, LA&raquo_space; LV pressure during diastole, RV lift, completely normal LV

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11
Q

Mitral stenosis diagnosis:

A

ECG signs of LA enlargement, RVH;
A fib;
CXR shows straightening of the L heart border;
Dilation of pulmonary veins;
Echo shows narrowed “fish mouth” shaped orifice

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12
Q

Medical therapy for mitral stenosis

A

Diuretics for pulm congestion, Digoxin, anticoagulant

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13
Q

Anesthetic concerns for Mitral Stenosis

A
  1. Slow (low HR to allow time for blood to fill ventricle);
  2. Regular (sinus rhythm);
  3. Not too full (maintain preload);
  4. Not too tight (maintain afterload-SVR);
  5. Not too strong (maintain contractility)
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14
Q

Pressure-volume loop for mitral stenosis

A
  1. Decreased preload;
  2. Decreased LVEDV;
  3. Decreased LVEDP;
  4. Decreased SV;
  5. Decreased EF
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15
Q

Pressure-volume loop for Mitral Regurgitation

A
  1. Increased LVEDV (compensation by LV chronic);
  2. Increased LVESV;
  3. Shortening of Isovolumetric contraction phase
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16
Q

How does Mitral Regurgitation cause eccentric LV hypertrophy?

A

As LV SV is pumped backward into the LA (increasing LAP), the LV compensates by dilating & increasing LVEDV (to maintain CO despite decreased SV). This eventually leads to increased LVESV

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17
Q

PE for Mitral Regurgitation

A

Diffuse and hyper dynamic ventricular impulse;

Systolic murmur best heard at apex, radiating to axilla, wide splitting S2; S3 d/t volume overload in LA

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18
Q

Large V wave in MR shows?

A

Decreased atrial and pulmonary compliance and increased pulmonary blood flow & regurgitant volume

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19
Q

Anesthetic concerns for MR

A
  1. Fast (high HR 80-100 bc brady worsens regurg);
  2. Forward (decrease afterload-SVR);
  3. Regular (maintain SR);
  4. Not too strong (maintain contractility)
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20
Q

Valve leaflets balloon upwards as the ventricle contracts

A

Prolapse

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21
Q

Abnormal closure of mitral valve produces what murmur of mitral regurgitation

A

Holosystolic

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22
Q

Sudden tension in mitral valve prolapse produces?

A

Mid-systolic click

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23
Q

Anesthetic concerns for mitral valve prolapse:

A

Avoid agents that increase HR or release histamines.

Select NDNMB that does not have circulatory effect

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24
Q

Pressure-volume loop for aortic stenosis

A
  1. Increased afterload;
  2. Increased LVESP (=200mmHg);
  3. Increased LVESV;
  4. Increased LVEDV;
  5. Decreased SV
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25
Q

What moves the loop to the right in AS?

A

Increased LVESV is added to incoming venous blood and increases LVEDV (preload). The increase in preload increases the force of contraction (Starling’s law)

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26
Q

What moves the loop upward in AS?

A

Concentric LVH limits overexpansion of LVEDV but increases LVEDP.

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27
Q

3 clinical symptoms associated with aortic stenosis that indicate poor prognosis:

A
  1. Angina w/o CAD d/t decreased O2 supply to the sub-endocardium by decreased ventricular diastolic compliance;
  2. Syncope and faintness;
  3. DOE
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28
Q

PE for Aortic stenosis

A

Paradoxical splitting of S2, very narrow pulse pressure d/t low SBP, S4(bc hypertrophic LV), systolic ejection murmur w/ LV pressure&raquo_space; aortic pressure during diastole

29
Q

Anesthetic concerns for AS

A
  1. Slow (HR);
  2. Full (maintain or increase preload);
  3. Tight (maintain or increase afterload to maintain coronary perfusion pressure);
  4. Regular (maintain SR);
  5. Not too strong (maintain contractility)
30
Q

Pressure-volume loop for Aortic regurgitation

A
  1. No Isovolumetric relaxation;
  2. No Isovolumetric contraction as blood still coming during systole;
  3. Increased LVEDV;
  4. Increased LVESP;
  5. Increased SV;
  6. Increased pulse pressure;
  7. Blood pours down both in systole & diastole causing increased volume & pressure
31
Q

Regurgitant flow from aorta to ventricle during diastole results in?

A

Eccentric hypertrophy (dilatation and volume overload)

32
Q

High pitch “blowing” diastolic murmur

A

Aortic regurgitation

33
Q

“Dancing carotid”- rapid rise followed by a rapid fall of carotid pulse a/w AR

A

Corrigan pulse

34
Q

“Bounding” femoral pulse a/w AR

A

Pistol-shot

35
Q

Diastolic bruit over femoral artery a/w AR

A

Duroziez sign

36
Q

Bobbing motion of head a/w AR

A

De Musset’s sign

37
Q

Systolic blushing & then diastolic blanching of the fingernail bed a/w AR

A

Quincke’s pulse

38
Q

Anesthetic concerns with aortic regurg:

A
  1. Fast (sinus tach will give less time for regurg);
  2. Full (slight increase in preload);
  3. Forward (low TPR/afterload to improve forward flow)
39
Q

Decreases compliance of arterial tree, thus leading to increase in pulse pressure

A

Arteriosclerosis

40
Q

Associated with low diastolic pressure and high systolic pressure, net result is very high pulse pressure

A

Patent ductus arteriosus

41
Q

Low diastolic and high systolic pressure leads to high pulse pressure

A

Aortic regurgitation

42
Q

Tx for malignant hypertension

A

IV nitroprusside and diuretics

43
Q

Antihypertensive for African American men

A

Diuretics (beta blockers not effective)

44
Q

Antihypertensive for diabetic pt with renal insufficiency, CHF

A

ACE inhibitors

45
Q

Antihypertensive for pt with exertional angina

A

Beta blockers

46
Q

Avoid which antihypertensives in elderly?

A

Clonidine (a2 agonist), prazosin (a1 antagonist) (causes orthostatic hypotension)

47
Q

Avoid which antihypertensives in smokers and COPD?

A

Beta blockers

48
Q

Avoid which antihypertensives in renal insufficiency?

A

Beta blockers and diuretics

49
Q

Avoid which antihypertensives in diabetes and gout?

A

Thiazide diuretics

50
Q

Most common cause of chronic cor pulmonale

A

COPD

51
Q

Clinical features of Cor Pulmonale

A 
Peripheral edema, liver enlargement, distended neck veins;
Loud P2 (normally A2 is louder)suggest pulmonary HTN; low sat, right axis deviation, increased mean pulmonary artery pressure
52
Q

Mean PA pressure a/w primary pulmonary HTN

A

> 25 mmHg (normal 12-16)

53
Q

Immune reaction against necrotic myocardium post MI a/w acute pericarditis

A

Dressler’s syndrome

54
Q

What does CXR show with pericardial effusion?

A

Globular shaped heart

55
Q

Cardiac tamponade leads to ______ of pressures

A

Equalization

56
Q

Dissension of JVP during inspiration a/w cardiac tamponade

A

Kussmaul’s sign

57
Q

Decrease in SBP > 10 mmHg during inspiration (normal drop =6) a/w cardiac tamponade

A

Pulses paradoxus

58
Q

PE with cardiac tamponade

A

Quiet heart sounds, increased JVP, & hypotension

59
Q

XR findings for cardiac tamponade

A

“Water bottle heart”

60
Q

Anesthetic considerations with cardiac tamponade

A

Ketamine induction, increase IV fluids, avoid vasodilation & cardiac depression

61
Q

Occurs when the heart becomes encased in a rigid, chronically inflamed, calcified pericardium

A

Constrictive pericarditis

62
Q

Pericardial knock

A

As the ventricles fill, the descending ventricles “knock” against the pericardium in constrictive pericarditis

63
Q

Tx for constrictive pericarditis

A

Surgical stripping of pericardial shell

64
Q

Type ___ aneurysm involves the ascending aorta while type ___ does not

A

A; B

65
Q

MCC of abdominal aortic aneurysm

A

Atherosclerosis

66
Q

PE with abdominal aortic aneurysm

A

Pulsatile abdominal mass, bruits, hypotension (if rupture)

67
Q

Signs of AAA rupture

A

Grey Turner’s sign, Cullen’s sign, CV collapse

68
Q

Location of atherosclerosis (greatest to least):

A

Abdominal aorta > coronary artery > popliteal artery > carotid artery

Patho II (11 decks)

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