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co-existing disease > exam 1 > Flashcards

exam 1 Flashcards

1
Q

What does an echo look at?

A
  1. size/shape of heart
  2. valve competency
  3. pumping capacity
  4. location and extent of tissue damage
  5. CO, EF, diastolic function
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2
Q

AS (preload/afterload)

A
  • increase/maintain afterload

- increase afterload

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3
Q

AR (preload/afterload)

A
  • decrease afterload

- increase preload

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4
Q

MS (preload/afterload)

A

-maintain after load and CO to prevent tachycardia (prevent dehydration AND fluid overload)

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5
Q

MR (preload/afterload)

A
  • decrease afterload

- decrease preload

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6
Q

MVP

A
  • increase after load

- increase preload

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7
Q

bare metal

A

wait 30-45 days before surgery

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8
Q

drug eluding

A

wait 1 year before surgery (aspirin 75-150mg/day pre-op except neurosurg)

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9
Q

AS murmur

A

2nd ICS, mid-systolic, radiates to carotids

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10
Q

AR murmur

A

3rd and 4th ICS, holo-diastolic, radiates to carotids

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11
Q

MS murmur

A

apex, mid-diastolic, radiates to axilla

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12
Q

MR murmur

A

apex, holo-systolic, radiates to axilla

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13
Q

MVP murmur

A

apex, late-systolic, mid-systolic click

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14
Q

assess coronary patency

A

angiography

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15
Q

Esmolol dose

A

0.5 mg/kg

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16
Q

vacuuming METS

A

3.5

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17
Q

6 cardiac risk factors

A
  1. IHD
  2. HF
  3. stroke/TIA
  4. DM requiring insulin
  5. CKD with Creatinine >2.0
  6. high risk surgery
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18
Q

breast surgery

A

low risk

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19
Q

monitor ischemia leads

A

II, V5 (95%)

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20
Q

Samter’s Triad

A
  1. Nasal Polyps
  2. Asthma
  3. Aspirin/NSAID intolerance
    (avoid Toradol with reactive airway disease)
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21
Q

H2 agonism

A
  • increase cAMP
  • smooth muscle relaxation/ bronchodilation
  • avoid H2 antagonists (Famotidine) with asthmatics
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22
Q

extubation criteria

A
  • sustained head lift (>5 sec)
  • NIF >-20cmH2O
  • VC >15ml/kg
  • PaO2 >60 mmHg with FiO2 <20
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23
Q

alpha-1 anti-trypsin deficiency

A
  • inherited or caused by smoking
  • inhibition of normal anti-proteases
  • increased protease activity
  • increased protein breakdown
  • emphysema
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24
Q

COPD loop

A
  • scooped out
  • baby carriage
  • pork chop
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25
Q

FEV1/FVC normal

A

0.8

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26
Q

obstructive (FEV1/FVC)

A

<0.7, FEV1 decreased

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27
Q

restrictive (FEV1/FVC)

A

normal or increased, FEV1 decreased

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28
Q

normal aortic valve size

A

2.5-3.5cm2

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29
Q

aortic stenosis A. Line waveform

A
  • pulsus tardus

- pulsus parvus

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30
Q

aortic stenosis time to death

  1. angina pectoris
  2. syncope
  3. dyspnea on exertion
A
  1. 5 years
  2. 3 years
  3. 2 years
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31
Q

aortic stenosis decrease murmur intensity

A

valsalva and sustained handgrip

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32
Q

aortic stenosis peri-op goals (4)

A
  1. maintain NSR
  2. avoid tachy or brady
  3. avoid hypotension
  4. optimize intravascular fluid volume
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33
Q

aortic stenosis CPR

A
  • not effective

- can’t create adequate stoke volume against stenotic valve

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34
Q

mitral stenosis

A

increases LA pressure and volume, pulmonary HTN, stress induced pulmonary edema, right CHF

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35
Q

at risk for mitral stenosis

A
  • females

- rheumatic heart disease

36
Q

normal mitral valve

A

4-6

37
Q

mitral stenosis EKG

A

broad notched P wave (A. Fib 1/3)

38
Q

mitral stenosis peri-op goals

A
  • maintain CO (avoid increased HR)
  • maintain NSR
  • maintain euvolemia
  • avoid hypercarbia, hypoxemia
  • epidural>spinal for HR/BP control
39
Q

aortic regurg

A
  • eccentric and concentric LV gypertophy
  • decreased coronary blood flow
  • LVF and pulmonary edema
40
Q

risk factors aortic regurg

A
  • Acute (endocarditis, aortic dissection, trauma)

- Chronic (rheumatic fever, bicuspid aortic valve, idiopathic aortic root dilation)

41
Q

severe aortic regurg

A

> 50%

42
Q

severity of regurg is a function of…

A
  • time (HR)

- pressure gradient (SVR)

43
Q

AR meds

A
  • PO (nifedipine, hydralazine)

- IV (nitroprusside, dobutamine)

44
Q

AR assessment

A
  • dyspnea, fatigue, angina
  • widening pulse pressure
  • bounding peripheral pulses
45
Q

AR peri-op goals

A

FAST-FULL-FORWARD

  • HR >80, consider IVF bolus and afterload reduction
  • avoid decreased HR and sudden increase SVR
  • GA>neuraxial
46
Q

AR induction

A

consider panc

47
Q

mitral regurg

A

-decreased SV and CO
-LA becomes volume overloaded (pulmonary congestion, LV hypertrophy, impaired contractility)
(chronic or acute)

48
Q

risks for MR

A

MVP, ischemic HD, LVH, previous rheumatic fever, congenital HD, lupus, rheumatoid arthritis

49
Q

severe MR

A

> 50%

50
Q

MR PA waveform

A

large V wave

51
Q

MR surgery

A

EF >60 beneficial

EF <30 futile

52
Q

MR anesthesia

A
  1. kep HR 80-100 (decrease ventricular filling time)
  2. slightly decrease SVR (maximize forward flow, reduce afterload, avoid further drop CO)
  3. caution with myocardial depressant drugs (my have ventricular impairment)
53
Q

MVP

A

(common, often benign)

  1. systole (one or both leaflets prolapse back into LA, with or w/o regurg)
  2. primary MVP (leaflets thickened d/t connective tissue dz)
  3. functional MVP (leaflets have mid bowing- normal variant)
54
Q

risk factor MVP

A
  • female
  • marfan’s
  • previous rheumatic fever
  • thyrotoxicosis
  • lupus
55
Q

diagnosis MVP

A

ECHO: valve prolapse of 2mm or more above the mitral annulus

most patients asymptomatic

56
Q

MVP anesthesia

A

want to increase LV filling and decrease LV emptying (a larger ventricle will have less prolapse)

  1. avoid prolonged SVR
  2. minimize SNS stimulation (avoid arrythmias)

avoid ketamine, no beta-agonists (ephedrine)

57
Q

normal aortic valve size

A

2.5-3.5cm2

58
Q

aortic stenosis A. Line waveform

A
  • pulsus tardus

- pulsus parvus

59
Q

aortic stenosis time to death

  1. angina pectoris
  2. syncope
  3. dyspnea on exertion
A
  1. 5 years
  2. 3 years
  3. 2 years
60
Q

aortic stenosis decrease murmur intensity

A

valsalva and sustained handgrip

61
Q

aortic stenosis peri-op goals (4)

A
  1. maintain NSR
  2. avoid tachy or brady
  3. avoid hypotension
  4. optimize intravascular fluid volume
62
Q

aortic stenosis CPR

A
  • not effective

- can’t create adequate stoke volume against stenotic valve

63
Q

mitral stenosis

A

increases LA pressure and volume, pulmonary HTN, stress induced pulmonary edema, right CHF

64
Q

at risk for mitral stenosis

A
  • females

- rheumatic heart disease

65
Q

normal mitral valve

A

4-6

66
Q

mitral stenosis EKG

A

broad notched P wave (A. Fib 1/3)

67
Q

mitral stenosis peri-op goals

A
  • maintain CO (avoid increased HR)
  • maintain NSR
  • maintain euvolemia
  • avoid hypercarbia, hypoxemia
  • epidural>spinal for HR/BP control
68
Q

aortic regurg

A
  • eccentric and concentric LV gypertophy
  • decreased coronary blood flow
  • LVF and pulmonary edema
69
Q

risk factors aortic regurg

A
  • Acute (endocarditis, aortic dissection, trauma)

- Chronic (rheumatic fever, bicuspid aortic valve, idiopathic aortic root dilation)

70
Q

severe aortic regurg

A

> 50%

71
Q

severity of regurg is a function of…

A
  • time (HR)

- pressure gradient (SVR)

72
Q

AR meds

A
  • PO (nifedipine, hydralazine)

- IV (nitroprusside, dobutamine)

73
Q

AR assessment

A
  • dyspnea, fatigue, angina
  • widening pulse pressure
  • bounding peripheral pulses
74
Q

AR peri-op goals

A

FAST-FULL-FORWARD

  • HR >80, consider IVF bolus and afterload reduction
  • avoid decreased HR and sudden increase SVR
  • GA>neuraxial
75
Q

AR induction

A

consider panc

76
Q

mitral regurg

A

-decreased SV and CO
-LA becomes volume overloaded (pulmonary congestion, LV hypertrophy, impaired contractility)
(chronic or acute)

77
Q

risks for MR

A

MVP, ischemic HD, LVH, previous rheumatic fever, congenital HD, lupus, rheumatoid arthritis

78
Q

severe MR

A

> 50%

79
Q

MR PA waveform

A

large V wave

80
Q

MR surgery

A

EF >60 beneficial

EF <30 futile

81
Q

MR anesthesia

A
  1. kep HR 80-100 (decrease ventricular filling time)
  2. slightly decrease SVR (maximize forward flow, reduce afterload, avoid further drop CO)
  3. caution with myocardial depressant drugs (my have ventricular impairment)
82
Q

MVP

A

(common, often benign)

  1. systole (one or both leaflets prolapse back into LA, with or w/o regurg)
  2. primary MVP (leaflets thickened d/t connective tissue dz)
  3. functional MVP (leaflets have mid bowing- normal variant)
83
Q

risk factor MVP

A
  • female
  • marfan’s
  • previous rheumatic fever
  • thyrotoxicosis
  • lupus
84
Q

diagnosis MVP

A

ECHO: valve prolapse of 2mm or more above the mitral annulus

most patients asymptomatic

85
Q

MVP anesthesia

A

want to increase LV filling and decrease LV emptying (a larger ventricle will have less prolapse)

  1. avoid prolonged SVR
  2. minimize SNS stimulation (avoid arrythmias)

avoid ketamine, no beta-agonists (ephedrine)

co-existing disease (1 decks)

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