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Anesthesia & Coexisting Disease > Ex1 L2 > Flashcards

Ex1 L2 Flashcards

1
Q

Ion most responsible for resting membrane potential

A

Potassium

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2
Q

What does not occur in SA node?

A

Rapid depolarization

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3
Q

Largest perfusion to coronaries

A

During diastole

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4
Q

Increased demand of O2 from

A

Increased:

HR, afterload, contractility

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5
Q

Simple form - angina pectoris

A

Mismatch of O2 supply & demand

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6
Q

Hearts way of compensating a mismatch in supply/demand of O2

A

Decreased HR + contractility

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7
Q

Angina pectoris risk factors

A 
Males
Increasing age
HTN
HL
Smoker
DM
Obesity
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8
Q

Stable angina

A

Chest pain not changing for 2+ months

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9
Q

Unstable angina

A

Pain at rest, new onset, or increase in severity/frequency

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10
Q

Angina - diagnosis

A

ECG

Non-invasive or invasive imaging

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11
Q

Best information of coronary arteries

A

Coronary angiography

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12
Q

Revascularization

A

CABG or PCI +/- stents for failed medical management
LMCA occlusion > 50%
Significant CAD + EF 40%

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13
Q

Tx STEMI

A 
MONA
Beta Blockers
Reperfusion therapy
PCI 
CABG
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14
Q

Beta blockers should be avoided in

A

HF
Low CO or cardiogenic shock
Heart block

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15
Q

Reperfusion therapy should occur

A

30-60 minutes from arrival

**w/in 12h of onset

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16
Q

PCI should occur within

A

90 minutes of arrival

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17
Q

After angioplasty (w/o stenting) - time to wait for elective surgery

A

2-4 weeks

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18
Q

After bare metal stent placement - time to wait for elective surgery

A

At least 30 days

12 weeks preferable

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19
Q

Reperfusion therapy

A

TPA alteplase etc.

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20
Q

Reperfusion therapy risk

A

History of bleeding or hemorrhagic stroke — careful

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21
Q

After CABG- time to wait for elective surgery

A

At least 6w

Prefer - 12 w

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22
Q

After DES placement - time to wait for elective surgery

A

At least 12 months

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23
Q

Periop monitoring - stent pts

A

Must have interventional cardiologist on staff/available

*STAT consult for angina

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24
Q

Anesthesia techniques for stent pt

A

Neuraxial techniques not prudent unless anticoagulants held for 5-10 days prior

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25
Q

DES < 12 months + dual antiplatelet therapy

A

**Consult cardiology
Emergency surgery is 3.5x risk adverse events
Major risk of adverse cardiac events if d/c antiplatelet therapy + non cardiac surgery

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26
Q

UA/NSTEMI diagnosis

A

3 principal presentations:

  1. Angina at rest ( > 20 min)
  2. chronic angina pectoris that is more easily provoked
  3. New-onset angina (severe)
    * often presents with arrhythmias
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27
Q

UA/NSTEMI ECG

A

Significant ST-segment depression in 2+ leads
+/or
Deep symmetric t-wave inversion

28
Q

UA/NSTEMI Tx

A

Decrease O2 demand
Bed rest, O2, analgesia, BB, CaBlockers, ASA/clopidogrel, heparin

NO THROMBOLYTIC THERAPY

29
Q

Cardiac risk factors in pts undergoing elective major non cardiac surgery

A
  • high risk surgery
  • IHD
  • CHF
  • CVA
  • IDDM
  • Cr > 2 mg/dL
  • more risk factors = greater risk of complications
30
Q

Hold ACE inhibitors when?

A

24h prior to surgery

31
Q

Intraop events that decrease O2 delivery

A 
Tachycardia
Decreased DBP
Hypocapnia 
Anemia
Arterial hypoxemia 
Shift of oxyhem —> L
Coronary artery spasm
32
Q

Intraop events that increase O2 requirements

A

Increased:

HR, BP, SNS, contractility, pre/afterload

33
Q

Intraop MI - Tx

A

Nitroglycerine

If needed: sympathomimetics (restore coronary pressure) + fluids (restore bp)

34
Q

Preferred volatile with intraop MI

A

Sevoflurane

35
Q

Evaluation of cardiac reserve

A

Exercise tolerance

36
Q

Cardiomegaly

A

Heart > 50% thoracic cage in chest radiograph

37
Q

Valve replacement that requires long-term anticoagulation

A

Mechanical (prosthetic)

38
Q

Pt cannot tolerate anticoagulation - which type of valve replacement do they most likely have?

A

Bioprosthetic

39
Q

Pt on Coumadin - major surgery planned. When to hold?

A

3-5 days preoperatively

IV/SubQ heparin or LMWH until day prior or day of surgery

40
Q

When is antbx prophylaxis recommended?

A
  1. Dental procedures (+ gingival/periapical/perf of oral mucosa)
  2. invasive procedures (incision/biopsy of resp/infected skin/skin structures/musculoskeletal)

**NOT GI/GU

*Exceptions: Congenital heart dx, cardiac transplant (cardiac valvulopathy), immunocompromised

41
Q

Commonly associated with mitral stenosis

A

Afib, pulmonary edema

over time—> pHTN, RHF

42
Q

Pts with mitral stenosis should be taking

A

Anticoagulation

Prevent embolic stroke: 7-15%

43
Q

Mitral stenosis: diagnosis

A

Echo

Valve area < 1.5 cm^2

44
Q

Opening snap - diastole (murmur)

A

Mitral stenosis

45
Q

Pulmonary edema - common in mitral valve stenosis when?

A

Afib, sepsis, pregnancy

46
Q

Mitral Stenosis - risks associated

A

High risk for systemic thromboembolism - should be on anticoagulation especially if Afib

47
Q

Mitral Stenosis - ECG

A

p wave notch (LA hypertrophy)

Not always

48
Q

Mitral Stenosis Tx

A
  1. Diuretics
  2. HR control (increased HR=increased LA pressure/decreased LV filling)
  3. Anticoagulation
  4. Surgery: symptomatic +/- pHTN
49
Q

Anesthetic Rx - Mitral Stenosis

A

Preop: anxiolytics to reduce tachy
Induction: balanced or nitrous/narcotics
*avoid ketamine, atracurium
Resume anticoagulation asap

50
Q

Wedge pressure in mitral regurgitation

A

Overestimate LV filling pressure

LAP > LVEDP

51
Q

Size of___ wave in PAOP correlates with _____

A

V wave

Magnitude of mitral regurgitation

52
Q

Mitral regurgitation - anesthetic goals

A

Afterload reduction
*CO - maintained (via increased HR, decreased SVR)
I.e. nitroprusside gtt to decrease SVR

53
Q

Induction Rx - Mitral regurgitation

A

Etomidate/Ketamine are okay — do not want to decrease HR

54
Q

Factors associated with aortic stenosis

A
  1. Degeneration/calcification of leaflets—> stenosis

2. Presence of bicuspid rather than tricuspid valve

55
Q

Most common valvular dx

A

Aortic stenosis

56
Q

Normal aortic valve area

A

2.5-3.5 cm^2

57
Q

Critical AS

A

Valve < 0.8 cm^2
+
Transvalvular pressure gradient > 50mm

58
Q

Aortic Regurgitation - maintenance mneumonic

A

Full, Fast, Forward

59
Q

A-Line changes with aortic regurgitation

A

Bisferins pulse

60
Q

ECG changes with aortic regurg

A

Widened QRS

61
Q

Goal hr/bp aortic regurg

A

Do not increase SVR (forward)

HR > 80, do not decrease (fast)

62
Q

Drug to avoid in aortic regurg

A

Phenylephrine (decrease HR)

63
Q

ECG changes - tricuspid regurg

A

Peaked p wave (leads II, III, aVF)

64
Q

Drugs to avoid in tricuspid regurg

A

Nitrous

65
Q

Causes of pulmonic valve regurg

A

pHTN

Anesthesia & Coexisting Disease (23 decks)

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