Evans

Question 1

preconditioning definition

Answer 1

short period of ischemia improves the hearts ability to tolerate longer periods of ischemic insult

Question 2

do VAA produce preconditioning effect?

Answer 2

yes, protects the myocardium from ischemia and reperfusion injury and reducing infarct size

Question 3

should VAA be used in hemodynamically stable cardiac surgery patients?

Answer 3

yes, means of reducing myocardial damage and death

Question 4

hibernation

Answer 4

self-preservation mechanism whereby left ventricular contractile function is reduced to match the amount of O2 available
less BF less contraction

Question 5

left ventricular perfusion-contraction matching results from:

Answer 5

stable coronary plaques cause chronic reduction in coronary perfusion, and steady-state ischemia occurs
this is part of hibernation

Question 6

how does CABG relate to hibernation?

Answer 6

significantly improved HF after CABG
ischemic myocardium considered viable
20-40% pts have significant improvement

Question 7

cardiac stunning

Answer 7

brief periods of ischemia lasting less than 20 minutes

reversible contractile dysfunction

Question 8

in cardiac stunning, does necrosis occur?

Answer 8

no

Question 9

how long can reversible contractile dysfunction (stunning) last?

Answer 9

several hours

Question 10

after CPBP & cardiac stunning, how long is inotropic support needed?

Answer 10

12-24 hours

Question 11

supply ischemia causes increase in _____ and a decrease in _______

Answer 11

increase in ventricular compliance (dilation)

decrease in contractility

Question 12

demand ischemia reduces _____ and effects contractility _______

Answer 12

reduces compliance (stiffening), without impacting contractility

Question 13

primary characteristics of remodeling are: (3)

Answer 13

hypertrophy or dilation
myocyte death
increased interstitial fibrosis

Question 14

clinical impact of ventricular hypertrophy:

Answer 14

change in systolic and diastolic function

Question 15

concentric ventricular remodeling: (pressure or volume)

Answer 15

pressure overload

Question 16

eccentric ventricular remodeling: (pressure or volume)

Answer 16

volume overload

Question 17

supply ischemia (from MI or chronic volume overload) causes what type of hypertrophy?

Answer 17

eccentric, dilation

Question 18

in eccentric hypertrophy, what happens to chamber size?

Answer 18

chamber size increases in attempt to preserve stroke volume (wall is thinner)

Question 19

what shape does heart become in dilated state?

Answer 19

spherical

Question 20

how does the body compensate for reduced SV?

Answer 20

SNS stimulation to increase HR

Question 21

Systolic heart failure is caused by:

Answer 21

CAD
dilated cardiomyopathy
chronic volume overload
chronic hypertension

Question 22

can pulmonary congestion develop with a normal EF?

Answer 22

yes

Question 23

can symptoms of heart failure develop with normal EF?

Answer 23

yes

Question 24

diastolic HF is often called:

Answer 24

HF with preserved EF (greater than 40%)

Question 25

demand ischemia results from:

Answer 25

chronic pressure overload s/t stenotic heart valves*
obstructive cardiomyopathy
chronic HTN
obesity

Question 26

demand ischemia causes what changes to heart?

Answer 26

thicker myocardium
concentric hypertrophy
decreased compliance

Question 27

why does pulmonary congestion develop in diastolic dysfunction?

Answer 27

fibroses, non-distensible LV is unable to fill adequately, despite near-normal systolic function

Question 28

concentric hypertrophy is prone to

Answer 28

ischemia

Question 29

what HR/MAP do you want in concentric hypertrophy?

Answer 29

normal HR

high MAP

Question 30

how do you treat hypotension in concentric hypertrophy?

Answer 30

phenylephrine

Question 31

in concentric hypertrophy/diastolic dysfunction, what happens if pt cardiac arrests?

Answer 31

chest compressions rarely generate enough pressure to perfuse hypertrophied, noncompliant LV

Question 32

As diastolic HF progresses, what happens?

Answer 32

systolic HF develops