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CV II Flashcards

1
Q

Every anesthetic has what kind of effect on the cardiovascular system?

A

Every anesthetic has either a direct or indirect effect on the cardiovascular system

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2
Q

The failing heart becomes increasingly dependent on circulating what?

A

The failing heart becomes increasingly dependent on circulating catecholamines**

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3
Q

Decreases in circulating catecholamine levels, such as can occur following induction of anesthesia (such as proprofol and fenatnyl) , may lead to what?

A

Decreases in circulating catecholamine levels, such as can occur following induction of anesthesia (such as proprofol and fenatnyl) , may lead to acute cardiac decompensation**

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4
Q

Arteriosclerosis is a chronic disease of the arterial system which is characterized by what?

A

Arteriosclerosis:
Chronic disease of the arterial system, characterized by:
-Abnormal thickening and hardening of vessel walls
-Decrease in the artery’s ability to change lumen size, lumen is gradually narrowed (changes in lipid, cholestoral, and phospholipid withing in tunica intima, which will contribute to arteriosclerosis

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5
Q

what are the pathophysiologic conditions of arteriosclerosis?

A

Pathophysiologic conditions;

  • High blood pressure*
  • Insufficient perfusion of tissues*
  • Weakening of arterial walls*
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6
Q

What is the leading contributor to coronary artery and cerebrovascular disease?

A

Atherosclerosis

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7
Q

How does atherosclerosis form?

A

Form of arteriosclerosis, thickening and hardening of the vessel walls are caused by soft deposits of intra-arterial fat and fibrin that harden over time

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8
Q

Approximately what fraction of people over the age of 65 have HTN?

A

Approximately two thirds of people over the age of 65 years have hypertension**

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9
Q

what is the primary risk factor for development of CAD?

A

HTN

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10
Q

How much of the population does HTN affect?

A

Affects ~ 60 million people

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11
Q

What is primary HTN?

A

Essential (primary) HTN

  • No identifiable cause
  • Accounts for 95% of all cases
  • Diagnosis determined on the basis of exclusion
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12
Q

What is Secondary HTN?

A

Remedial (secondary) HTN

  • Has an identifiable and curable cause
  • Causes of secondary HTN include;
  • –Pheochromocytoma, coarctation of the aorta, renal artery stenosis, primary renal diseases, Conn’s disease (primary aldostaronism?), and Cushing’s disease (hyper cortisol)
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13
Q

What is the pathophysiology of HTN?

A

Pathophysiology:

  • Some degree of sympathetic dysfunction is responsible for essential HTN
  • Dysfunction of the sympathetic nervous system leads to chronic vasoconstriction (intravascular volume status will decrease)
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14
Q

What is the goal of antihypertensive therapy??

A

To maintain normal tension on a consistent basis

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15
Q

True or false?

Anesthesia care providers must have an adequate understanding of agents used to treat HTN

A

True.

Anesthesia care providers must have an adequate understanding of agents used to treat HTN

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16
Q

What should you do with medications for HTN until the time of surgery?

A

Anesthesia management:
Medications for HTN should be continued on schedule until the time of surgery***

Mild preoperative sedation may be indicated

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17
Q

what may happen with anesthesia induction agents and with patients with hypertension?

A

Anesthesia induction agents may induce hypotension (patients maybe hypovolumic)

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18
Q

Patients with HTN react in a exaggerated response to what two things??

A

Patients with HTN react in an exaggerated response to induction agents and stimulation**

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19
Q

Patients with HTN, what is the goal for the maintenance of anesthesia?

A

maintenance of anesthesia:

  • Goal is to maintain BP stability within 20% of the normal mean pressure
  • Intra-op events causing wide fluctuations in BP should be anticipated and treated
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20
Q

With patients that have HTN, what is the most common event precipitating intra-op HTN??

A

Surgical stimulus is the most common event precipitating intra-op HTN (may wanna give narcotic before stimulus)

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21
Q

Patients with HTN, What intra-op condition should be immediately recognized, diagnosed, and treated??

A

Profound hypotension during surgery should be immediately recognized, diagnosed, and treated

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22
Q

Patients with HTN, Intra-op cardiac morbidity is associated with what?

A

Intra-op cardiac morbidity is associated with prolonged severe hypotension

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23
Q

What are the postoperative considerations for patients with HTN?

A
  • Early in the postoperative period initiation of adjunct administration of antihypertensive medications should be considered
  • Primary antihypertensive consideration is the adequate control of pain
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24
Q

How much fluid should be in the pericardium?

A
  • Pericardial space usually contains 20-25 ml of clear fluid
  • Under normal circumstances can accommodate gradual fluid fluctuations
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25
Q

What is the pericardium consist of?

A

Consists of an inner visceral (think organ) layer and an outside parietal layer

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26
Q

Rapid accumulation of pericardial fluid in the pericardial space can result in what two events?

A

Rapid accumulation of pericardial fluid in the pericardial space can result in cardiac tamponade and cardiovascular collapse

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27
Q

ACUTE PERICARDITIS - Acute inflammation of the pericardium is caused by a number of disorders that include?

A

ACUTE PERICARDITIS
Acute inflammation of the pericardium is caused by a number of disorders (can be caused by post MI syndrome, metastatic disease, TB, rheumatoid arthritis, viral infection)

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28
Q

What are the clinical presentation of acute pericarditis?

A
  • Chest pain with sudden onset is the associated principle symptom
  • Inclusion of a pleural component
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29
Q

Chronic constrictive pericarditis results from what?

A

Results from pericardial thickening and fibrosis (back in the day tb was the cause, most common cause is idopathic)

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30
Q

What is the anesthetic management of chronic constrictive pericarditis?

A

Anesthetic agents should preserve myocardial contractility* (will be fixed), heart rate* (don’t want this to go down), preload* (will be fixed), and afterload

31
Q

What is cardiac tamponade?

A

Intrapericardial pressure is influenced by the accumulation of fluid

32
Q

What is the pathophysiology of cardiac tamponade?

A

Pathophysiology:

  • Accumulation of pericardial fluid causes an increase in intrapericardial pressure
  • Poor ventricular filling develops
  • Decrease in SV stimulates compensatory mechanisms for maintaining CO
  • Cardiac collapse can occur if compensatory mechanisms fail (first HR will increase, vasoconstriction)
33
Q

What is the pathophysiology of heart failure?

A

Systolic heart failure occurs when the heart is unable to pump a sufficient amount of blood to meet the body’s metabolic requirements

34
Q

What is reduced in most forms of heart failure?

A

CO is reduced in most forms of heart failure**

35
Q

What is the compensatory mechanisms for the pathophysiology of heart failure?

A

Compensatory mechanisms:

  • Increased preload
  • Increased sympathetic tone (2nd to NE and Epi)
  • Activation of the renin-angiotensin-aldosterone system (eventually this is a good compensatory system but at a certain point it will fail)
  • Release of AVP (argenin vasopressin increase ventrular afterload in the attempt to increase SV) )(primary goal is to increase O2 to the tissue, this is done by increase SV)
  • Ventricular hypertrophy
36
Q

Initially compensatory mechanisms are effective in the pathophysiology of heart failure, but eventually what may happen?

A

Initially compensatory mechanisms are effective, with increasing severity of cardiac dysfunction compensatory mechanisms may contribute to cardiac impairment

37
Q

With cardiac risk factors, CV complications account for how much of deaths following noncardiac surgery?

A

CV complications account for 25-50% of deaths following noncardiac surgery

38
Q

Intra-op MI, pulmonary edema, CHF, arrhythmias, and thromboembolism are most commonly seen in patients what patient population?

A

Intra-op MI, pulmonary edema, CHF, arrhythmias, and thromboembolism are most commonly seen in patients with preexisting CV disease

39
Q

What are the two most important preoperative cardiac risk factors?

A

Two most important preoperative risk factors:

  • History of recent MI* (less than one month)
  • Evidence of CHF*
40
Q

With cardiac risk factors, what are the three generally accepted contraindications to elective noncardiac surgery?

A

Generally accepted contraindications to elective noncardiac surgery include:

  • MI less than 1 month prior to surgery
  • Uncompensated heart failure
  • Severe aortic or mitral stenosis
41
Q

What are the preoperative considerations of ischemic heart disease?

A

ISCHEMIC HEART DISEASE
Preoperative considerations:
Myocardial ischemia is characterized by a metabolic oxygen demand that exceeds oxygen supply

42
Q

What are the risk factors that are associated with CAD?

A

k factors associated with CAD (include htn Dm smokin, increase in age, male gender, positive family history, hyperlipidemia)

43
Q

What usually reflects underlying coronary disease and frequently precedes MI?

A

Unstable angina

44
Q

What patient population has a relatively high incidence of silent ischemia (ones with chronic stable angina)?

A

Diabetics have a relatively high incidence of silent ischemia

45
Q

With what condition does blood flow generally is adequate at rest but becomes inadequate with increased metabolic demand?

A

Chronic stable angina

46
Q

What is the treatment of ischemic heart disease?

A

Correction of complicating medical conditions that can exacerbate ischemia

47
Q

For the treatment of ischemic heart disease, what would pharmacologic manipulation consist of?

A

Pharmacologic manipulation of the myocardial oxygen supply-demand relationship

48
Q

What are the three most common pharmacologic agents used to treat ischemic heart disease?

A

Most commonly used pharmacologic agents:
-Nitrates (relax vascular smooth muscle, reduce wall tension and after load)
-Calcium channel blockers (reduce myocardial o2 demand by decrease after load, will decrease) coronary blood flow)
-β-adrenergic blocking agents reduce hr and contractility and reduce after load
Other agents (antidysritimcs, ace inhibitors)

49
Q

Patients with ischemic heart disease and regional anesthesia should be used for what procedure?

A

Regional anesthesia for extermitites, perineum, and lower abdomen, avoid marked hypotension, avoid excessive sedation

50
Q

General anesthesia with ischemic heart disease should be aim at what?

A

Maintenance agents; good ventricular function managed with volatile anesthetic-based technique, depressed ventricular function managed with opioid based anesthetic

51
Q

What are the postoperative management for patients with ischemic heart disease?

A

Possible 12-lead ECG to detect unrecognized ischemia

Provide supplemental oxygen until adequate oxygenation is established

52
Q

What is the normal valve orifice for mitral stenosis?

A

Symptoms generally develop after 20-30 years, normal valve orifice is reduced from 4-6 cm2 to less than 2 cm2***

53
Q

With mitral stenosis, blood flow depends on what three factors?

A

Blood flow depends on HR, CO, and atrial kick

54
Q

What is the anesthetic management for mitral stenosis?

A

Principle goals are to maintain sinus rhythm, avoid tachycardia, large increases in CO, hypovolemia, and fluid overload**

55
Q

Patients with mitral regurgitation, what is the principle derangement?

A

Principle derangement is a reduction in forward stroke volume*** systole will have backward blood flow

56
Q

What happens in patients with Mitral regurgitation in terms of the LV?

A

LV compensates by dilating and increasing EDV in the attempt to increase forward volume

57
Q

For the anesthetic management of mitral regurgitation, what should be avoided?

A

Slow heart rates and acute increases in afterload should be avoided

58
Q

For the anesthetic management of mitral valve prolapse, what should be avoided?

A

hypovolemia and factors that increase ventricular emptying should be avoided

59
Q

For the anesthetic management of patients with mitral valve prolapse, what should you do with asymptomatic patients and ATB?

A

Asymptomatic patients; ATB prophylaxis

60
Q

For patients with aortic stenosis, obstruction is usually gradual to where?

A

Obstruction is usually gradual to left ventricular outflow

61
Q

With aortic stenosis, CO may be what at rest?

A

CO may be normal at rest but does not appropriately increase with exertion

62
Q

With aortic stenosis, what drugs do we use and what do we monitor for?

A

Treatment diuertics, digoxin

Monitoring: for ischemia

63
Q

Aortic regurgitation can be classified as what?

A

Maybe chronic or acute

64
Q

Aortic regurgitation may do what to volume?

A

Produces volume overload of the LV

65
Q

With aortic regurgitation, what happens to stroke volume?

A

Effective forward stroke volume is reduced

66
Q

With aortic regurgitation, what happens to diastolic pressure and SVR?

A

Systemic arterial diastolic pressure and SVR are low

67
Q

With aortic regurgitation, what is the volume dependent on?

A

regurgitant volume dependent on HR and diastolic pressure gradient across the aortic valve

68
Q

What happens to the autonomic influences in patients with a transplanted heart?

A

Transplanted heart is denervated so direct autonomic influences are absent

69
Q

What happens to cardiac impulse formation and conduction in patients with a transplanted heart?

A

Cardiac impulse formation and conduction are normal

70
Q

What happens to circulating catecholamines in patients with a transplanted heart?

A

The response to circulating catecholamines is normal or even enhanced

71
Q

What happens to the CO in patients with a transplanted heart?

A

CO tends to be low-normal and increases relatively slow in response to exercise

72
Q

What should the preoperative evaluation focus on with a patient that will be getting a transplanted heart?

A

Preoperative evaluation should focus on evaluating the functional status of the transplanted heart and detecting complications associated with immunosuppression

73
Q

What is the anesthetic management for a patient with a transplanted heart?

A
  • Nearly all anesthetic techniques have been used successfully
  • Maintenance of a normal or high cardiac preload desirable
  • Indirect vasopressors are less effective ephedrine
  • Isuprel and epinephrine should be available to increase HR
  • HR related responses to various medications administered intraoperatively are absent

Bioscience (9 decks)

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