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CV Anesthesia > Final > Flashcards

Final Flashcards

1
Q

Heart failure classification

Comfortable at rest
Slight limitation of physical activity

A

Class II mild

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2
Q

Heart failure classification

Marked limitation of physical activity

Less than ordinary activity results in fatigue, palpitation, or dyspnea

A

Class III. Moderate

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3
Q

Heart failure classification
Symptoms of cardiac insufficiency at rest

Unable to carry out any physical activity without discomfort

A

Severe

Class IV

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4
Q

Type of cardiomyopathy

Systolic dysfunction

Eccentric LV enlargement

A

Dilated (congestive) cardiomyopathy

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5
Q

Type of cardiomyopathy

Diastolic dysfunction

Concentric hypertrophy

Dynamic outflow obstruction

A

Obstructive cardiomyoptahy

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6
Q

Abnormal diastolic dysfunction.

Abnormal E:A

A

Restrictive cardiomyopathy

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7
Q

Failure of LV leads to increased ____________

A

LVEDP

LVH

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8
Q

Best vasopressor for heart failure patient

A

Ephedrine better than phenylephrine

NE better than ephedrine

Vasopressin if cant get NE

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9
Q

Highest mortality post transplant is when

A

Within first 6 months

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10
Q

90% of heart transplant is due to

A

Idiopathic or ischemic dilated cardiomyopathy

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11
Q

6 contraindications to heart transplant

A

Severe elevation in PVR

Psych factors/compliance

Irreversible renal, hepatic, pulmonary function

Co-existing disease with poor prognosis

Uncontrolled malignancy

Active infectious process

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12
Q

Minimize ischemic time of donor heart. Usually less than

A

4 hours

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13
Q

Donor heart is denervated and electrical activity

ECG appearance

A

Cannot cross suture line

2 P waves

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14
Q

Due to denervation which sympathomimetic have no effect

A

Indirect bc loss of SNS, PNS innervation to heart

Use direct: epi, NE, isoproterenol

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15
Q

Management of RV failure after transplant (4)

A

Optimize preload (starling pyramid)

Provide early inotropic support

Maintain low PVR

Consider mechanical support (IABP, RV assist device)

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16
Q

3 drug classes ot maintain low PVR

A

Nitrates

Prostaglandins

Nitric Oxide

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17
Q

Post transplant considerations for anesthesia

A

No hemodynamic response to DL and light anesthesia and pain

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18
Q

Induction in heart failure patients (3)

A

Slower induction

Maintenance of compensatory mechanisms

More potent vasopressors

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19
Q

4 indications for VADs

A

Heart failure

Circulatory support during surgery

Recovery from MI

Destination therapy

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20
Q

LVADs are dependent on

A

Reasonable RV function

Normal PAP

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21
Q

Often used to improve pulmonary hypertension and RV function

A

Epoprosterenol (Flolan)

Nitric oxide

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22
Q

TEE findings that contraindicated LVAD placement

A

AI

PFO

VSD

ASD

Severe RV dysfunction

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23
Q

Unique considerations of VAD hemodynamics

A

Inconsistent LV ejection

Use MAP instead of SBP/DBP

Optimize RV function

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24
Q

Current durable VADS have _______ flow

A

Non-pulsatile continuous flow

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25
Q

What 2 things decrease LVAD flow

A

Hypovolemia and increased afterload

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26
Q

TEE exam after LVAD implantation watch for

A

SUCKDOWN

Need adequate preload

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27
Q

Post-implantation management of LVAD includes

A

Anticoagulation

Avoid high pump speeds

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28
Q

Prior to surgery should assess

A

Patient function

End organ damage

Doppler/US available

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29
Q

Anesthesia plan for pt with LVAD

A

Faster fuller vasodilation

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30
Q

Post implant LVAD hemodynamic goals

MAP

Pulse pressure

A

MAP 70-80. Avoid >90mmHG

PP 10 mmHG

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31
Q

No _________ for LVAD patients

A

Spinal or epidural

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32
Q

Anesthesia for LVAD patients

A

Avoid hypovolemia and pulmonary hypertension

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33
Q

If in doubt about pump function during arrest you should do what?

A

Listen for humming

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34
Q

ICD settings intraop for pt with LVAD

A

Rate of 100

Tachytherapies off

35
Q

Parameters of VAD console

Pump flow

Pump speed

Pump power

Pulsatility

A

Flow 4-6 lpm

Speed 8000

Power 4-8

Pulsatility 4-6

36
Q

Biggest risk of VADs

A

Infection

Stroke

37
Q

Left to right shunts aka

A

Acyanotic

38
Q

3 congenital defects associated with left-to-right shunts

A

ASD

VSD

PDA

39
Q

Right-to-left shunts aka

A

Cyanosis

40
Q

Common cyanotic congenital defects

A

Tetralogy of Fallot

Transposition of great arteries

Single ventricles

41
Q

Defect which typically allows parallel circulation physiology to exist

A

TGA and turn us arteriosus

42
Q

4 classes of meds used in medical mgmt of LV failure in perioperative period

A

Diuretics

Digoxin

ACE inhibitors

Beta blockers

43
Q

3 potential causes of pulmonary hypertension in pt with existing or repaired CHD

A

Presence of long-standing large nonrestrictive defects

Elevated LVEDP, PAP, or PA stenosis

Decreased O2 sat

44
Q

Predictors of mortality with Eisenmenger syndrome

A 
Syncope
Age at presentation
Poor functional class
Atrial dysrhythmias
Elevated RAP
Low O2 sat
Severe RV dysfunction
Trisomy 21
45
Q

Findings in Eisenmenger’s Syndrome

A

Loud pulmonic 2nd heart sound

PT murmur

EKG RVH

Impaired exercise tolerance

Palpitations

Hemoptysis

Syncope

Heart failure

46
Q

Primary goals of anesthetic management in patient with pulmonary hypertension

A

Minimize increases in PVR

Maintain SVR

47
Q

Factors increasing pulmonary output

A

Decreased PVR

Increased SVR

48
Q

Causes of decreased PVR

A

Hypocapnia

Pulmonary vasodilator

49
Q

Causes of increased SVR

A

SNS stimulation

Vasoconstrictor

Hypothermia

50
Q

Factors increasing systemic output

A

Increased PVR

Decreased SVR

51
Q

Causes of increased PVR

A

Hypoxemia

Hypercapnia

High hematocrit

PPV

Cold

Metabolic acidosis

Alpha-adrenergic stimulation

52
Q

Causes of decreased SVR

A

Vasodilators

Spinal/epidural

Deep GETA

Hyperthermia

53
Q

7 measures to prevent and treat acute pulmonary hypertension

A

Hyperventilate (normocapnia)

Correct acidosis

Avoid SNS stimulation

Normothermia

Minimize intrathoracic pressure

Inotropic support

Inhaled nitric oxide

54
Q

Coagulation alterations in pt with cyanotic heart disease that may lead to coagulopathy and/or thrombosis

A

Low levels of vit-k dependent clotting factors, VWF, factor V (elevated INR)

55
Q

Ventricular dysrhythmias are most frequently encountered in patiens with

A

Significantly decreased RV or LV function

Acute hypoxemia

56
Q

Supraventricular dysrhythmias occur in

A

20-45% of pt with previous atrial surgery

57
Q

Dilated cardiomyopathy typically involves

A

Systolic dysfunction

Eccentric hypertrophy

58
Q

Obstructive cardiomyopathy typically involves

A

Diastolic dysfunction

Concentric hypertrophy

59
Q

Restrictive cardiomyopathy typically involves

A

Diastolic dysfunction

Abnormal filling

60
Q

Induction in heart failure patients involves

A

Slower induction

Maintenance of compensatory mechanisms

More potent vasopressors (ephedrine, NE, vasopressin)

61
Q

Indications for VADs

A

Heart failure

Circulatory support during surgery

Recovery from MI

Destination therapy

62
Q

LVADs are dependent on

A

reasonable RV function

Normal PAP

63
Q

2 drugs often used to improve pulmonary hypertension and RV function

A

Epoprosterenol (Flolan)

Nitric Oxide

64
Q

TEE findings which may contraindicated LVAD

A

AI

PFO

VSD

ASD

Severe RV dysfunction

65
Q

Unique considerations of VAD hemodynamics

A

Inconsistent LV ejection

Use of MAP exclusively

Optimizing RV function

66
Q

Post implant management of LVAD includes

A

Anticoagulation

Avoid high pump speeds (<9800rpm)

67
Q

Prior to surgery should assess

A

Patient function

End organ damage

Have doppler/US available

68
Q

Avoid what with LVAD

A

Hypovolemia

Pulmonary HTN

CPR but defibrillated as needed

69
Q

If in doubt about pump function during arrest do what

A

Listen for humming of motor

70
Q

Biggest risks of LVAD

A

Infection

Stroke

71
Q

ASD large shunt when

A

> 20mm

72
Q

Risks with ASD

A

Pulmonary blood flow increased

Atrial dysrhythmias

Emboli stroke

Pulmonary HTN

73
Q

Effects on heart of ASD

A

RV enlargement

74
Q

VSD closure typically for defects >

A

5mm

75
Q

Risks of VSD

A

Endocarditis

AI

76
Q

Coarctation of aorta results in

A

Chronic pressure overload of LV (compensatory hypertrophy)

Always hypertensive

77
Q

Most common cyanotic congenital heart disease

A

Tetralogy of Fallot

78
Q

Even after tetralogy of Fallot corrected continue to have

A

Hypoxemia

RV dysfunction

79
Q

Tetralogy of Fallot associated with what dysrhythmias

A

Ventricular

80
Q

4 components of tetralogy of Fallot

A

Narrowing PA

Thickening RV

Displacement of aorta over VSD

VSD

81
Q

Blalock-Taussig shunt considerations

A

Relieves poor oxygenation symptoms

Affects BP and pulse ox on operative side

82
Q

Palliative repair for single ventricle

A

Fontan repair

83
Q

3 congenital defects associated with L to R shunt in adult

A

ASD/VSD

Coarctation of aorta

Congenital aortic valve disease

Correction of transposition of great vessels

Epstein’s abnormality of tricuspid

CV Anesthesia (4 decks)

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