Exam 3 Cardiovascular disease Flashcards
What is the most common cause for PVD?
Atherosclerosis
What are the treatments for PVD?
Pharmacologic & Surgical (transluminal angioplasty, endarterectomy, thrombectomy, bypass)
What is the primary goal in PVD surgery monitoring?
Detection of cardiac ischemia
What is warranted in PVD surgery monitoring?
An art-line.
How is the ABPI calculated?
Dividing the ankle’s SBP by the arm’s SBP
An ABI of <0.25 means, what?
Impending gangrene
Where is the most common atherosclerotic plaque buildup?
At the carotid bifurcation
What happens to the vessel in a dissection?
Blood enters media layer from tear in intima
How does cross-clamping affect the body?
- LV afterload increases,
- severe HTN
- compromises perfusion to distal organs & spinal cord
What happens after d/c of cross clamping & how can this be alleviated?
Systemic hypotension & by preloading with volume
What 2 lesions require cardiopulmonary bypass?
Ascending aorta & transverse aorta
What is a Stanford type A dissection?
Dissection in the ascending aorta that may or may not extend into the descending aorta
What is a Stanford type B dissection?
Dissection limited to descending aorta
What is the source for aortic issues in someone with Marfan’s?
Medial cystic necrosis
What is the difference between a true & false aneurysm?
- True involves dilation of all 3 layers.
- False is caused by disruption of 1 or more layers
What is the leading cause of abdominal aortic aneurysms?
Medial cystic necrosis
Most aortic aneurysms are due to?
Atherosclerosis
How does a pseudoaneurysm form?
The intima & media layers are ruptured & only the adventitia or blood clot form the outer layer
What is the hallmark sign of aortic trauma?
Wide mediastinum on CXR
What is the most common cause for postoperative renal failure?
Preoperative renal dysfunction
What is the difference between a saccular & fusiform aneurysm?
- Saccular is an eccentric dilation.
- Fusiform includes the entire circumference of aorta
What are the S/S of acute dissection?
- Sharp, tearing pain
- hypo/hypertension,
- absent peripheral pulses
- paraplegia/paraparesis
Which aneurysm has a strong genetic link & usually relates to?
- Abdominal aneurysm.
- Atherosclerosis
At what size does an abdominal aneurysm needs to be repaired?
Starting at 5-6cm
What are the classic symptoms of Abd aneurysm rupture?
Hypotension, back pain, pulsatile mass
What do we have to be very cautious with in someone with a ruptured abd aneurysm?
Raising their BP
What are the best intraoperative BP meds?
Meds that are fast on & fast off like nitroprusside
What is a Cooley Type D?
Fusiform aneurysm from ascending to renal arteries (entire aorta)
What is a Cooley Type B?
Fusiform aneurysm from ascending to proximal arch
What is a Cooley Type A?
Saccular aneurysm in the transverse arch
What is a Cooley Type C?
Fusiform aneurysm from ascending to proximal descending
What is a major complication of thoracic aorta clamping?
Spinal cord ischemia & paraplegia
What are the S/S of anterior spinal artery syndrome?
Loss of motor function & pinprick sensation but preserved vibration & proprioception
In 60% of people the artery of Adamkiewicz is located where?
Left side of T9-T12
What are 4 protective measures for paraplegia?
- Methylprednisone
- Mild hypothermia
- Mannitol
- CSF drainage
How is Spinal cord perfusion pressure calculated?
MAP – CSF
Giving Mannitol before cross-clamping can lead to what?
Renal failure
What can be given to someone with elevated creatinine pre & post a procedure involving contrast?
Mycomyst BID
At what cross-clamping time do paraplegia & ARF increase drastically?
> 30 mins
What opioids are preferred in vascular cases?
Fast acting like Remifentanil
